By: Eric Klein, MD
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If you’ve been diagnosed with prostate cancer, don’t assume that surgery or radiation therapy is in your future. First, talk to your doctor about how aggressive your cancer may be. While surgery or radiation is best for some aggressive cancers, it’s not always necessary.
The role of active surveillance
For slow-growing, low-risk prostate cancers, active surveillance may be a better option. That’s when your cancer is monitored with periodic clinic visits and prostate-specific antigen (PSA) tests and repeat biopsies every year or two. Surgery or radiation can be done later if the cancer begins growing significantly.
A study published in the New England Journal of Medicine indicates that there is a tendency to over-diagnose and overtreat non-threatening prostate cancers. Known as the PIVOT trial, the study shows that many men with low-grade, low-volume tumors don’t need to be treated.
Another recent study in the same journal showed the risk of dying of prostate cancer is no different for eligible men who were managed by surveillance than by radiation or surgery.
Routine PSA tests cut risk
Prostate cancer is the second deadliest type of cancer in men, after lung cancer. The American Cancer Society estimates that more than 180,000 men will be diagnosed with it and more than 26,120 will die of it in 2016.
That’s why it’s important to have prostate cancer screenings — PSA tests plus digital rectal exams. In fact, a Cleveland Clinic study shows that routine PSA tests reduce the risk of developing metastatic prostate cancer. But just because screenings may detect prostate cancer, it doesn’t mean the cancer needs to be treated.
We are enthusiastic about using active surveillance with appropriate patients, and we use the latest tools available for finding cancers, such as multiparametric MR scans. We also helped develop genetic-based tests to make it easier to distinguish between aggressive and non-aggressive tumors. Both of these tests provide more confidence about the decision to observe or treat the cancer.