Treatment can do more harm than good for prostate cancer − why active surveillance may be a better option for some
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January 26, 2024
Jinping Xu, Chair of Family Medicine and Public Health Sciences, Wayne State University -
The Conversation
Although about 1 in 8 men in the U.S. will be diagnosed with prostate cancer during their lifetime, only about 1 in 44 will die from it. Most men diagnosed with prostate cancer die from other causes, especially those with a low-risk prostate cancer that usually grows so slowly it isn’t life-threatening.
However, until about a decade ago, most men diagnosed with low-risk prostate cancer were immediately treated with surgery or radiation. Although both can cure the cancer, they can also have serious, life-changing complications, including urinary incontinence and erectile dysfunction.
I am a family physician and researcher studying how patient-physician relationships and decision-making processes affect prostate cancer screening and treatment. In our recently published research, my colleagues and I found that men are increasingly opting against immediate treatment. Instead, they are choosing a more conservative approach known as active surveillance: keeping a close eye on the cancer and holding off on treatment until there are signs of progression.
Prostate cancer screening trouble
Prostate cancer screening is controversial because it often leads to overdiagnosis and overtreatment of cancers that would have otherwise been harmless if left undetected and untreated.
Screening for prostate cancer typically uses a blood test that measures levels of a protein that prostate cells produce called prostate specific antigen, or PSA. Elevated PSA levels may indicate the presence of prostate cancer, but not all cases are aggressive or life-threatening. And PSA levels can also be elevated for reasons other than prostate cancer, like an enlarged prostate gland due to aging.
Due to widespread PSA screening in the U.S., over half of prostate cancers detected through screening are low-risk. Concerns about overdiagnosis and overtreatment of low-risk cancers are the main reasons why screening is not recommended unless patients still want to be screened after discussing the pros and cons with their doctor.
What is active surveillance?
Active surveillance is a safe and effective way to manage low-risk prostate cancer by limiting treatments such as surgery or radiation only to cancers that are growing or becoming more aggressive. It involves monitoring tumors through regular checkups and tests.
Active surveillance is different from “watchful waiting,” another conservative strategy with a less intense type of follow-up that includes fewer tests and only relieves symptoms. In contrast, active surveillance involves more rigorous monitoring, with more tests to keep a close eye on cancer with the intention to cure if needed.
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