Prostate cancer needs monitoring

DEAR DOCTOR K: After an abnormal PSA test and biopsy, I have been diagnosed with early-stage, nonaggressive prostate cancer. My doctor advised active surveillance. What does this mean?

DEAR READER: Prostate cancer is the uncontrolled growth of abnormal cells in the prostate. This walnut-size gland sits below the bladder, in front of the rectum, near the base of the penis. Prostate cancer is common, but it is not always dangerous.

These days, many prostate cancers are discovered through screening. Some of them will not grow, spread and become serious medical problems.

Of course, some of them are serious. When deciding on a course of treatment, your doctor must first determine whether your cancer is life-threatening.

Treatment comes with risks, including erectile dysfunction and urinary incontinence. And neither you nor your doctor wants you to have a treatment if it is worse than the disease.

Indeed, some men need no treatment – for example, older men with other serious and life-threatening health issues, or men with slowly progressing early-stage cancer. Other men, say younger men with aggressive cancer, require treatment.

But today, a significant number of men fall into a gray area, where the decision of whether to treat isn’t clear-cut. Like you, these men have tumors that are so small and apparently slow-growing that they meet the criteria for active surveillance.

At a minimum, close monitoring means digital rectal exams and prostate-specific antigen tests every four to 12 months. Biopsies should be done every one to three years.

If PSA readings increase sharply, or if the doctor feels a new lump during a DRE, it may be time to start treatment. A change in urinary habits (needing to go urgently, or not being able to go) can also signal it’s time for active therapy.

We just haven’t yet developed a perfect test for estimating the risk the cancer will be a “bad one.” But we have learned enough to know if a person is in the “gray area,” active surveillance is the most sensible approach.