Beyond Active Surveillance for Early Prostate Cancer

Beyond Active Surveillance for Early Prostate Cancer

More and more guys with early-stage prostate cancer—the kind that may never grow enough to need treatment—are choosing a smart, proven strategy called active surveillance. Docs keep a close eye on the cancer, allowing men to postpone or completely dodge radiation, surgery and associated complications. New research proves it’s safe and effective, but one new report uncovered many men’s surprising misconceptions about prostate cancer.

In a survey of 260 men with a new diagnosis of early-stage, localized prostate cancer, doctors from Wayne State University found that three out of four men expected their cancer would kill them in less than a decade if they didn’t get treatment right away. And more than 50 percent believed that opting for cancer treatment would guarantee them at least 10 to 12 more years. Both groups were flat-out wrong.

Active surveillance helps more than 95 percent of men with early prostate cancer live for 10 years or longer by catching the fast-growing tumors that require surgery or radiation and keeping an active eye on the rest of the men. Treating early-stage cancers that aren’t growing rapidly, doesn’t give you a survival advantage in the first 10 years.

For the right men, active surveillance is a great way to sidestep the incontinence and erection problems that often accompany surgery and radiation. Johns Hopkins University researchers followed 1,298 men with low-risk prostate cancer who opted for active surveillance and found that fewer than 1 percent saw cancer spread or become fatal over 15 years. By monitoring growing tumors for guys who eventually needed treatment—about one in four—they were able to have treatment 8.5 years later, rather than right after their diagnosis. That’s a good deal!

New research also demonstrates that adding important lifestyle changes to active surveillance lowers your odds for ever needing surgery or radiation. In a study of 93 men with early-stage prostate cancer, University of California San Francisco researchers found that those who ate well and exercised regularly had lower PSA scores one year later, while those who didn’t take these steps saw their scores rise.

Currently only 30 percent of guys who could take advantage of active surveillance do, so here’s what you should know about this alternative.

Find out if it’s right for you. Prostate cancer is common, but grows so slowly that most men who have it will die from something else. To determine if your cancer is low-risk, your doc will evaluate several factors. These include your PSA score and PSA density (measures of prostate specific antigen, a protein that can be a cancer marker), the amount of cancer present, the stage of your tumor, and your Gleason score, which predicts your cancer’s aggressiveness. And make no mistake; Cancer that’s spread or is considered aggressive needs treatment right away.

Understand and follow your monitoring plan. If you’re a candidate for active surveillance, regular monitoring will feature digital rectal exams and PSA tests every six months and biopsies, too. But surveillance can only work when it’s done correctly—and a shocking study suggests it often isn’t. When University of California Los Angeles scientists checked the health records of 37,687 men with prostate cancer, they discovered that just 4.5 percent were monitored properly. Write test dates in your calendar or plug them into the appointment app in your smartphone so you don’t forget. Consider them unbreakable.

Make healthy upgrades. Participants in the lifestyle-change study ate a vegan diet—mostly fruits, vegetables, whole grains, and beans and soy, along with vitamin and mineral supplements. They did moderate-intensity aerobic exercise (walking almost every day), did yoga and meditation regularly and went to a weekly support group. (For more info on how to adopt these lifestyle upgrades, check out Dr. Mike’s Cleveland Clinic Wellness Institute at Taking these steps also reduces your risk for heart attacks, strokes and diabetes—supercharging your health and life for years to come.

Medically reviewed in December 2018.

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