Prostate Cancer Impacts 1 in 6 Men in the US
According to Kevin Loughlin, Urologist at Brigham and Women’s Hospital in Boston, “If prostate cancer survivors were a city, it would be the 4th largest in the US.”
Alarming as this statement is, the lifetime risk of dying from prostate cancer is only 3%. That means that most men who are diagnosed with prostate cancer will usually not die of prostate cancer but of something else. Why is that?
Slow Growth and A Sensitive Test
Most prostate cancer grows slowly–it can take 10 to 30 years before a prostate tumor gets big enough to cause symptoms. Since the majority of men diagnosed with prostate cancer are 65 and over, the odds of dying from it are reduced. Additionally, many prostate cancers are found early because of the Prostate-Specific Antigen test (PSA test). This highly sensitive test can detect very small tumors, even those that are not causing symptoms.
In fact, because of this, there are many men living and coping with uncertainty. Hearing your doctor tell you that you have cancer can be terrifying. The diagnosis of localized low risk prostate cancer is one in which patients need to be informed because there are three basic choices of treatment. See the infographic below.
This is the definition of a localized low risk prostate cancer.
To clarify this quote, a total Gleason score (between 2 and 10) is given by the pathologist who sees the biopsy tissue of the cancer. Most cancers range between 6 to 10 according to Dr. Steven Kaplan. A low grade means that the cells in the cancer look a lot like the normal cells in the prostate. A high score means that the cells in the cancer do not look like normal cells. A higher score indicates a more aggressive cancer.
Choices? Active Surveillance, Surgery, Radiation Therapy
One of those choices, active surveillance has been in the news recently. Active surveillance requires patients to engage in a strict protocol of tests to be sure that the cancer has not changed over time. The tests include digital rectal exams, PSA tests and biopsies.
Is Scanxiety Occurring?
In a study conducted in Switzerland and reported at this year’s American Urological meeting, half of the 157 patients diagnosed with localized low risk prostate cancer dropped out of the active surveillance program. The patients who stayed with active surveillance skipped 60% of their scheduled PSA tests. Dr. Kurt Lehmann stated that around 25% of the patients in this study had to move forward to either surgery or radiation therapy. This active surveillance program is being conducted at a community hospital, not a major medical center.
Yet another study of 1000 patients followed in active surveillance for 15 years, Dr. Laurence Klotz described only 2.5% of the patients did not comply with the protocol. Of the entire group, 60% were able to avoid surgery or radiation therapy. A full write-up of this AUA presentation can be found here.