Note: you will not find surgery listed here, nor will you find chemotherapy as it has not been proven to be effective for prostate cancer.
Active Surveillance is based on the concept that low-risk prostate cancer is unlikely to harm you or decrease your life expectancy. Over 30% of men have prostate cancers that are so slow growing and “lazy” that Active Surveillance is a better choice than immediate local treatment with surgery or radiation. Of the top 10 most common cancers, prostate cancer is the only one in which so many patients have a slow-growing tumor that does not warrant aggressive immediate treatment.
Active Surveillance is not “no treatment,” but rather a strategy to monitor your diagnosis.
It can feel counterintuitive to be told that you have cancer, but that the best option is to sit and wait. But studies show that men with low-risk prostate cancer who have been on Active Surveillance for 10 to 15 years after diagnosis have remarkably low rates of their disease spreading or dying of prostate cancer. In fact, a Johns Hopkins study of men on Active Surveillance found that, 15 years later, less than 1% of men developed metastatic disease. This is important because treatments used for localized prostate cancer—surgery and radiation—have side effects that can alter a person’s quality of life.
The key to these successful numbers is making sure you are monitored regularly for signs of progression. A PSA blood test and digital rectal exam (DRE) are usually done once or twice per year by your urologist, with a repeat biopsy of the prostate every 1 to 5 years. If there is evidence that the cancer is progressing, treatment may be warranted.
Active Surveillance may also be more appropriate for men who are currently battling other serious disorders or diseases—such as significant heart disease, long- standing high blood pressure, or poorly controlled diabetes. In a patient with other health issues, the patient and his doctors might feel that performing invasive tests or treatment would cause more harm than benefit. For these men, their treatment plan would of course help manage any symptoms that occur due to advanced disease. There are also some men with favorable intermediate risk who may be good candidates for Active Surveillance.
As with any treatment for prostate cancer, shared decision-making with a physician is necessary. Some physicians also administer commercial genetic tests—such as Decipher, Oncotype Dx® Prostate, and Prolaris®—that may be helpful in determining if you are a good candidate for Active Surveillance.
LDR brachytherapy uses iodine-125 and palladium-103 stored in titanium cases usually referred to as brachytherapy seeds. As the name permanent brachytherapy suggest, the seeds are permanently left inside the prostate gland. Over the course of their radioactive lives, the seeds will continuously emit low levels of radiation.
High Intensity Focused Ultrasound, or HIFU, is a therapy option for patients with localized, "organ confined", prostate cancer, where the tumor is still confined to the organ and has not spread to other areas of the body. HIFU is one of the few prostate cancer treatments that can be considered a minimally invasive, out-patient, radiation-free procedure where the patient does not require an overnight hospital stay. If the prostate cancer returns after initial treatment using HIFU, it does not rule out other treatment options and can be used again as needed.
During HIFU, the ultrasound waves heat up to 195-degrees Fahrenheit and target the affected prostate tissue for 2-3 seconds, leaving the healthy area around the target unharmed. Tissue Change Monitoring Software (TCM) makes it possible for surgeons to monitor changes in the prostate tissue during HIFU therapy in real time. Surgeons see how the prostate tissue is reacting to the ultrasound waves and alter treatment as needed. The precision of the Sonablate HIFU allows for flexibility in the procedure, making it possible for physicians to offer a customized treatment plan tailored to each patient's diagnosis.
For all forms of HIFU, treatments only last a few hours, and a catheter is usually worn for one to four weeks post-procedure. Patients are able to return to normal activity in a short amount of time.
A radiation oncologist uses CT scans images to pinpoint the exact location of the prostate each day of treatment. Since the prostate can move around by as much as a centimeter depending on how full your bladder and rectum are. IGRT can also be modified if a man loses weight. Using the daily CT scans, doctors compare current images with prior ones and fine-tune the treatment accordingly.