Prostate Cancer: New Active Surveillance Options

Some Patients Can Be Spared from Aggressive Treatment

Prostate cancer is the number one cancer diagnosed in men in the United States, and is the second leading cause of cancer related death.  More aggressive screening over the last few decades has resulted in more men being identified as having prostate cancer.  But it is well documented that a large percentage of prostate cancer grows very slowly and men with this low risk prostate cancer do not need aggressive treatment with surgery or radiation therapy.  They can live a normal lifespan and will die from something else long before the prostate cancer becomes an issue.

prostate-cancer-treatment options CTThe Problem with Traditional PSA Screening

Traditional screening is done with a digital rectal exam (DRE) and Prostate Specific Antigen (PSA) blood test.  An elevated PSA usually leads to a biopsy and if cancer is found, aggressive treatment with surgery or radiation is recommended.  There are many problems with that approach, which you can learn more about here.

What Is Active Surveillance?

Active Surveillance refers to a process by which a man with localized, low risk prostate cancer is actively monitored to continually assess the state of his disease. It requires the use of tests to determine that it is low risk disease, and can accurately measure any progression that may signal the need for more aggressive treatment. The monitoring can use conventional blood tests, like PSA, PSA velocity or PSA density, and prostate biopsies to keep track of the cancers progression. There are also new gene tests and imaging tests that can be used in conjunction with and often in place of the more conventional procedures.

The Data on Blind Biopsies for Prostate Cancer

Usually, identifying and removing a cancer is curative and the best option.  But with prostate cancer, the treatment often is worse than the disease.  Surgery and radiation frequently leaves a man either sexually impotent or incontinent.

But here are the numbers:

prostate-cancer-alternative treatments CT

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What’s wrong with this picture is that 90% of patients with low-risk prostate cancer will still get invasive, aggressive treatment despite only a 3% chance that the cancer will progress or become deadly.

Clearly, if you have an aggressive cancer, surgery or radiation may save your life and the long term side effects may be worth it.  But for men with low risk disease that has little chance of ever progressing, the long term side effects are very hard to justify.

New Options for Prostate Cancer Patients

There now are three options that can help to more accurately determine a patient’s risk of having an aggressive cancer and which patients are candidates for Active Surveillance:

  1. Prostate Cancer (PCA3) test – a gene test that measures the activity of a gene that is specific to prostate cancer.  It is measured in the urine following a DRE.  If your PCA3 score is below the cutoff of 25, then there is less than a 15% chance that a biopsy will be positive.  And, the majority of the positive biopsies are overwhelmingly likely to be low risk.
  2. Multiparametric Prostate MRI (mpMRI) – a noninvasive imaging test that increases the accuracy and identification of cancers in the prostate gland.  It can identify lesions in patients with elevated PSA levels but negative prior biopsy, guide biopsies in patients who are candidates for active surveillance, provide serial information on the size of tumors under active surveillance, provide reassurance that low-risk patients do not harbor significant disease, and identify lesions for localized therapy.  It can help reduce the incidence of unnessary surgery and radiation treatments.
  3. Oncotype DX –   a test performed on the cancer specimen obtained via biopsy.  It measures 17 cancer-specific genes in the tumor to determine its underlying biology.  This test predicts the aggressiveness of the tumor and helps patients and their doctors make more informed treatment decisions.

If you are concerned about whether you are making the best decisions for your prostate cancer care, we encourage you to contact Alternity Healthcare at (860) 561-2294 to explore your options.