Monitoring vs. Treatment for Prostate Cancer
Other than skin cancer, prostate cancer is the most common cancer among American men. The American Cancer Society estimates that about 1 in 8 men will be diagnosed with prostate cancer during his lifetime 1. In addition, about 1 in 41 will die of prostate cancer 1. Regular health checks are valuable to identify any signs or symptoms early. However, not all cases of prostate cancer benefit from treatment – monitoring without treatment is an option for some. It is thus critical to understand and weigh the risks and benefits of monitoring versus treatment options across a wide range of prostate cancer cases.
Watchful waiting is often recommended for older men when the cancer is unlikely to affect their natural lifespan 3. Men are thus only treated if they develop symptoms from their cancer. A few large studies have compared watchful waiting and surgery for early-stage prostate cancer, but the evidence from these studies has been mixed. While some have found that men who do choose to have surgery might live longer, others failed to identify any differences whatsoever in survival rates 2.
Active surveillance also aims to avoid unnecessary treatment of harmless cancers while, in contrast to watchful waiting, still providing timely treatment for patients who warrant it 3. Active surveillance for prostate cancer is also called expectant management 4. In active surveillance, medications, radiation and surgery are not used. However, periodic tests are carried out to check for signs the cancer is growing, usually every few months. Patients may expect a digital rectal exam, prostate-specific antigen blood tests, ultrasound or magnetic resonance imaging, and collections of prostate cells (a prostate biopsy). Frequent testing as an elevated form of monitoring facilitates a quick and early transition to treatment for prostate cancer if the patient’s situation changes.
Active surveillance may be considered for prostate cancer if the cancer is small, expected to grow slowly, confined to one area, and is not resulting in any ostensible signs or symptoms 2. This is relevant because some very small cancers may never cause signs and symptoms since prostate cancer progresses very slowly.
A number of studies have compared active surveillance monitoring to treatment via surgery or radiation therapy for prostate cancer. Men who undergo surgery or radiation do not appear to live longer than those that undergo active surveillance. However, their cancer may spread less, and they may remain remission-free for longer.
The risks of active surveillance for prostate cancer include anxiety, frequent medical appointments, cancer growth, and fewer treatment options. However, a more recent large-scale study found that, at a median follow-up of 15 years, among a large population of participating men, prostate cancer–specific mortality was low regardless of treatment. The choice of therapy thus involves weighing trade-offs between the risks and benefits associated with various treatment options for localized prostate cancer.
If it is warranted, treatment for prostate cancer can be caried out in variety of ways 5. These traditionally include surgery and radiation therapy. Other therapies that are still under investigation can also be used in the treatment of prostate cancer. These span various forms of cryotherapy, chemotherapy, biological therapy, hormone therapy, and high-intensity focused ultrasound.
Choosing monitoring, whether watchful waiting or active surveillance, versus treatment for prostate cancer is difficult. It is critical for a patient to talk openly with their oncologist about the treatment options available for their type and stage of cancer. Their doctor can further elaborate on the risks and benefits of each treatment and their side effects and help shed light on an informed, context-dependent decision 6.
References
1. Key Statistics for Prostate Cancer | Prostate Cancer Facts. Available at: https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html. (Accessed: 23rd May 2023)
2. Observation or Active Surveillance for Prostate Cancer. Available at: https://www.cancer.org/cancer/types/prostate-cancer/treating/watchful-waiting.html. (Accessed: 23rd May 2023)
3. Prostate cancer – Treatment – NHS. Available at: https://www.nhs.uk/conditions/prostate-cancer/treatment/. (Accessed: 23rd May 2023)
4. Active surveillance for prostate cancer – Mayo Clinic. Available at: https://www.mayoclinic.org/tests-procedures/active-surveillance-for-prostate-cancer/about/pac-20384946. (Accessed: 23rd May 2023)
5. How Is Prostate Cancer Treated? | CDC. Available at: https://www.cdc.gov/cancer/prostate/basic_info/treatment.htm. (Accessed: 23rd May 2023)
6. Prostate cancer – Diagnosis and treatment – Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/prostate-cancer/diagnosis-treatment/drc-20353093. (Accessed: 23rd May 2023)