Historically, too many men were haphazardly treated for prostate cancer. Happily, the incidents of over treatment have been declining and the general acceptance of Active Surveillance has emerged as the preferred management strategy for men with very low–risk prostate cancer. However, There is still too few high-quality comparative effectiveness studies evaluating the incremental risks associated with or active surveillance.
In a prospective study published in the Journal of Urology, researchers reported the risk men face of developing metastatic disease. They evaluated a large, mature, active surveillance cohort.
It was reported that, at median follow-up of 6 years, 3.1% of men in the surveillance cohort developed metastatic prostate cancer. They found that three situations were all associated with increasing risk of a man developing metastatic disease:
1- The presence of Gleason 7 disease
2- PSA doubling time less than 3 years
3- The presence of three or more positive cores on initial biopsy
The decision to pursue active treatment for prostate cancer is not clean cut. It needs to have, as a major decision component, a risk based benefit analysis. These data can help us better understand the incremental risks associated with surveillance as we move a head with our decision-making.
When I was initially diagnosed at age 59 with prostate cancer I read 5 books and went to over 50 websites as I came to a decision to WAIT!! The best piece of advice I encountered was to get a Second Opinion on the Gleason from a world class expert (then there were about six of them). Dr. Jonathan Epstein at Johns Hopkins read the slides as Gleason 3+3=6 rather than the original Gleason 3+4=7!! That made all the difference in my decision making over the ensuing years.
I chose Active Objectified Surveillance (AOS) and in February 2016 my PSA was down to 0.9. When I started AOS in 2006 (PSA was as high as 5.9) my urologist said he would work with me – that he had “one other” patient doing the same thing. When I had my PSA checked (1.4 in July 2011) I was told there are 30 men in that practice following AOS.
The diagnosis and the remedy are TWO distinct steps. Get treatment if it is really needed but avoid incontinence and impotence if you can live with the knowledge you have a “little bit of cancer” which were the words I first heard in December 2006.