10. What are my treatment options if I have a low-risk prostate cancer?
If you have low-risk prostate cancer, the path is not as straightforward. You should have a shared decision-making conversation with your doctor about active surveillance.
A shared decision-making conversation is when your doctor gives you evidence-based advice based on your personal health history and preferences. Then, you can make care choices with your doctor that work best for you based on your doctor’s advice.
What is active surveillance?
National guidelines and medical associations recommend active surveillance as the care path for most low-risk prostate cancer cases. Active surveillance means to monitor the cancer rather than treat it with surgery, radiation, drugs or hormones.
Patients on active surveillance have regular tests to watch for changes in their body. The tests include:
- Blood tests
- Additional biopsies
Some people check in with their care team about every 6 months to get a blood test or imaging test. Many people get another biopsy every 18 months to 2 years. If there are changes, your doctor may say you should go on active treatment.
It’s important to point out the word “active” in active surveillance. This doesn’t mean doing nothing. It’s actively keeping an eye on your condition through regular (on a planned schedule) tests and visits with your doctor.
Choosing active surveillance allows patients to avoid the side effects of radiation, surgery and hormone therapy. These side-effects may include:
- Urinary incontinence (not being able to start and stop urine)
- Trouble getting an erection
- Infertility (not being able to have children)
Choosing active surveillance requires a commitment on your part to keep your regular check-ups. The schedule will be different for each person.
It’s important to keep in mind, active surveillance isn’t a new idea. It’s been around for more than 20 years.
Can I change my mind about active surveillance?
Yes. Many people decide to go off active surveillance due to anxiety and not because their cancer has changed. They or their loved ones cannot tolerate the idea of having a cancer, even a low-risk cancer.
In contrast, some patients with low-risk prostate cancer that get treatment still have anxiety. Many patients find that after being on active surveillance for a while their anxiety lessens.
Each person is different, which is why it’s important to have shared decision-making conversations.
Is active surveillance the same as “watchful waiting”?
No, active surveillance and watchful waiting are different ways of handling an illness. But many people often think of them as the same thing.
Watchful waiting is only for very sick patients that have other conditions. For them, the active monitoring of prostate cancer, which includes biopsies, may cause health problems.