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Multiple options available for prostate cancer treatment Research looks at surgery vs. active surveillance THE FIRST INSTINCT when someone is diagnosed with cancer is to want immediate surgery. You want it out, eradicated, destroyed. But oddly enough, when it comes to prostate cancer, waiting can sometimes be a viable option. Active surveillance versus early surgery for prostate cancer is of interest to researchers because of the cancer’s potentially slow growth rate. A recent study from Sweden showed that early surgery cuts death by 38 percent in men younger than 65 with low-risk prostate tumors. But this is only the case for men younger than 65, while early surgery in men older than 65 did not significantly improve survival rates. Ben Kay, M.D., a urologist who practices at University Hospital, said determining the best prostate cancer treatment really comes down to individualized care and the patient’s circumstances. “If the patient has low grade, low volume disease, then that patient is a candidate for almost any of the treatment options, and that would include surgery, radiation or active surveillance,” he said. Active surveillance can include checking prostate specific antigen tests every three months, digital rectal exams every three to six months and repeat prostate biopsies at around a year to a year and a half. “We follow the patient closely to check for any upgrading of the cancer,” Dr. Kay said. “If there is a rapid rise of PSA over time, or if the repeat biopsies show an
“If the patient has low grade, low volume disease, then that patient is a candidate for almost any of the treatment options.” Ben Kay, M.D., Urology increase in grade or volume of cancer, it gives us the sign that the prostate cancer may be more aggressive than we first thought and the patient and physician may need to reconsider treatment options.” For men older than 65, there are a number of factors that come into play when determining the best prostate cancer treatment path. Age, life expectancy and overall health all come into play when physicians look at possible treatment options. For even younger men diagnosed with prostate cancer – those in their 30s, 40s or even 50s – Dr. Kay said there is a fine line between jumping straight into surgery and taking the time to watch how the cancer grows. “In my opinion, active surveillance is still an option of treatment for younger patients,” he said. Dr. Kay noted that deciding to utilize active surveillance is based on a number of factors, which makes it vital to have in-depth conversations with your physician before making a choice. “That conversation with the urologist is so important, because the patient needs to know all of his options before making a decision regarding his care plan,” Dr. Kay said. v
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