October 25, 2016

My Prostate Cancer: I Wish I'd Chosen "Active Surveillance" -- not Surgery -- in 1995

Most men in Sweden with low risk cancers are now opting for surveillance rather than quick invasive treatment… and more American men should make that same choice, according to a recent report.

Combined with my personal experience, this news is just the latest in a series of reports that have convinced me that the quality of my life would have been greatly enhanced if I had not decided to have surgery after my 1994 prostate cancer diagnosis.

Study of Men in Sweden
In a study of nearly 33,000 Swedish men diagnosed with very low risk (stage T1) prostate cancer between 2009 and 2014, those subjects who chose “active surveillance” increased from 57 percent to 91 percent during those years.

"For men who were diagnosed with low risk prostate cancer, it is important to know that active surveillance is an accepted way to manage the cancer," said lead researcher Dr. Stacy Loeb, assistant professor in the urology department at NYU's cancer center in New York City.

"There is no rush to get treatment -- low risk prostate cancer can be safely monitored," she said. "Some men will eventually need treatment, but others will be able to preserve their quality of life for many years."

In the United States, the majority of men with low risk prostate cancer choose speedy treatment, which can have side effects like urinary and erectile problems, Loeb said.

I can confirm that.

Active surveillance isn't wait-and-see, she explained. It involves regular blood tests and biopsies to gauge growth tumor growth. Should those tumors grow to the point where treatment becomes necessary, then it's time for surgery or radiation.

British Report on Risk of Dying
A recent British trial showed that ten years after men were diagnosed, the risk of dying from prostate cancer was the same whether they initially chose monitoring or opted for surgery or radiation, Loeb said.

The report, published online October 20 in the journal JAMA Oncology, concludes:
A growing body of evidence indicates that active surveillance can preserve quality of life without posing substantial short- to intermediate-term oncologic risk. Based on this evidence, a recent guideline endorsed by the American Society of Clinical Oncology (ASCO) now clearly states that surveillance is not merely an option for men with low-risk disease but rather is the preferred alternative for any clinically localized cancer.
My Prostate Cancer​
I was diagnosed with prostate cancer in 1994. I celebrated my 65th birthday that same year, and celebrated the first week of my retirement by having my prostate removed in early January, 1995.

Post-operative PSA tests showed that some cancer cells remained. Since 1995, I've checked in with my urologist every six months for both the "finger" and the PSA tests. My PSA has increased slowly from 0.2 in March 1995 to 6.0 this September.

After my January 1995 prostatectomy, my urologist told me that the postoperative biopsy convinced him that the operation was needed. But seeing the slow growth in the PSA in the 21 years since then makes me question his assessment.

Back then, I typically chose action over inaction when confronted with a choice of doing something or nothing. I might've been better off if instead I’d followed my current mantra; "less is more."

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