Active surveillance (AS) is now essentially the most common selection for men diagnosed with low-risk prostate cancer, during which the tumor is confined to the prostate gland and is unlikely to grow or spread. AS is just not a passive option. This includes monitoring prostate-specific antigen (PSA) levels for changes and regular digital rectal exams to envision for abnormal areas in your prostate.
But can AS be a journey that lasts eternally? When do you recognize when it is best to take the off-ramp?
to decide on
The goal of AS is to delay surgery or radiation to avoid potential unwanted effects of those treatments, comparable to erectile dysfunction, incontinence, and bowel function problems. The selection to pursue AS begins after a prostate biopsy to find out the cancer's size and likelihood of spread. “AS is an excellent option for men with low-volume, low-risk cancers that have not spread,” says Dr. Kabal.
A PSA test measures the quantity of a selected protein within the blood that’s produced by each cancerous and non-cancerous prostate tissue. PSA levels are measured in nanograms per milliliter (ng/mL). Generally, a PSA level between 4 and 10 ng/mL is taken into account borderline range and suggests a 25% probability of prostate cancer. Levels above 10 ng/mL increase the chance of cancer by greater than 50%. Also, a persistent rise in PSA levels over time is usually a sign of cancer.
The Gleason scale uses a 2 to five classification to rate how the 2 commonest forms of cells in a tumor taken from a prostate biopsy look in comparison with normal prostate cells. The scores for every are added together to get the Gleason rating. A grade no higher than 6 often means you might be at low risk for prostate cancer and will likely be offered lively surveillance as a treatment option.
If you select AS, the standard plan features a PSA test and a digital rectal exam about every six months, and a repeat prostate biopsy about every other 12 months. If your PSA level suddenly rises or your rectal exam shows something abnormal, your doctor will likely recommend a prostate MRI or a prostate biopsy first to seek out out. See if the cancer has develop into more aggressive.
“If there is evidence that the cancer has become more active, you and your doctor will discuss treatment options such as radiation, hormonal therapy, or surgery to remove the prostate gland,” says Dr. Kabel.
The waiting game
How long are you able to stay on AS? “As long as your condition doesn't change, you can stay on AS indefinitely,” says Dr. Kabal. Men can proceed on AS for 10 years or more.
Still, certain circumstances may prompt men to reconsider staying on AS. One is psychological – constant worry and anxiety that something might go incorrect. “For men with a family history of aggressive prostate cancer, the long wait and see process can be very stressful,” says Dr. Kabel. “If they feel they ultimately need treatment, they want to move forward and can't wait any longer.” Another similar factor is the so-called AS fatigue where men tire of the constant monitoring required by AS.
Increasing age can lead one to remission of AS, but without progression to treatment. If you might be still on AS in your late 70s or early 80s with a life expectancy of lower than 10 years, you could want to think about a less intensive approach called watchful waiting. With watchful waiting, you continue to need to visit the doctor sometimes. But to avoid the stress of constant testing and potential unwanted effects, prostate cancer surveillance stops, with no more biopsies.
“The goal is no longer to cure your cancer, but to treat it,” Dr. Kibble says. “The condition is that the cancer is growing so slowly that it's not a long-term threat, even if it progresses,” says Dr. Kabel.
If you later develop symptoms that indicate cancer progression—comparable to extreme fatigue, weight reduction, urinary retention, or bone pain—you could need to discuss with your doctor about your goals. and what options you will have for reducing cancer-related symptoms.
Ultimately, men should do not forget that they’re at all times in the motive force's seat after they are on AS. “It comes down to weighing the risks and benefits and working with your doctor to determine if it's best to stay on AS, or if it's time to make a change,” says Dr. Cable.
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