Table of Contents

Chapter 2: Initial Treatment: Weighing the Pros and Cons of Each Option

a. Active Surveillance

We know that some prostate cancers grow more slowly than others, and that, some men are less likely to get sick and/or die from their cancers. If the treatments were easy and had few side effects, the unnecessary treatment of slow-growing cancers would clearly be outweighed by the benefits that appropriate treatment would bring. But, as we’ll discuss in more detail later, the available treatments for prostate cancer are serious, and can have a long-lasting effect on how you live your life. Consequently, determining when to initiate treatment can be one of the most difficult decisions to make.

The concept of active surveillance, or watchful waiting, has increasingly emerged in the past years as a viable option for men who, for one reason or another, have decided not to undergo immediate surgery or radiation therapy. Although some might say that active surveillance is just postponing treatment, the truth is that for men who have very slow growing or very early cancers, immediate treatment might not make sense. Instead, they might choose to undergo vigilant monitoring, with frequent PSA and DRE tests. Additionally the use of ultrasound, CT, bone scans, or MRI might be used to watch for disease growth and the need for treatment. Active surveillance might also be a good choice for men who have other serious medical conditions that affect the way they live their lives, especially if these other conditions are likely to shorten their lifespan.

Are you a good candidate for active surveillance? That, of course, can only be determined after full consultation with your doctors. Two recent studies evaluating this question have found that men who are older than age 65 as well as those who have low-grade tumors at diagnosis might do well with this approach. Put more bluntly, these men are likely to have fewer symptoms related to their disease and are more likely to die with prostate cancer than die of prostate cancer.

Another important factor that your doctors are likely to consider is how healthy you are overall. Many of the treatment options for prostate cancer can be difficult to endure, and the healthier you are going into treatment, the more likely you are to have better outcomes. If you’re currently battling other disorders or diseases, such as heart disease, long-standing high blood pressure, or poorly controlled diabetes, your doctors might feel that it is in your best interest to hold off on therapy and avoid its potential complications.

When it comes down to it, every man’s circumstances are unique, and there’s no magic formula to knowing whether active surveillance is right for you. If you talk with your doctors and carefully weigh the pros and cons of the different treatment options before coming to any decision, you should be able to feel confident that the choice that you make is right for you.