Living Life on the Edge: The Bold Choice of Active Surveillance for Prostate Cancer

Active Surveillance for Prostate Cancer A Risk Worth Taking

Prostate Cancer Active Surveillance a Leap of Faith

Nov. 7, 2023 – When Allan Greenberg was diagnosed with prostate cancer in 2012, he decided to take a rather daring approach to tackle the disease. Brace yourselves… he did practically nothing. Instead of opting for the traditional treatments like radiation or surgery, Greenberg chose active surveillance, which basically means keeping a close eye on the cancer without immediate intervention. He would only seek treatment if things took a turn for the worse. Talk about living life on the edge!

Fast forward to today, at the ripe age of 83, Greenberg’s prostate cancer has shown minimal change. Now, in the winter of his life, he is seriously contemplating throwing caution to the wind and forgoing both active surveillance and treatment altogether. But hey, he hasn’t made up his mind just yet.

“At my age, treatment is the last thing I would consider,” Greenberg said whimsically from his cozy home in Vermont. “Even if things seem to be getting worse, I’m not sure I would go through any treatment at this point.”

Now, you might be wondering, if treatment is off the table, why bother with surveillance at all? Excellent question! That’s the dilemma that thousands of aging men face when dealing with a low-grade prostate cancer diagnosis made many years ago.

Active Surveillance: A Dance with Destiny

Active surveillance is the name of the game for prostate cancer patients who are hesitant to jump into the treatment pool right away. It basically involves regular monitoring sans the aggressive treatments. Prostate-specific antigen (PSA) blood tests, MRIs, and biopsies are the tools of the trade when it comes to keeping an eye on things.

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Now, hold your horses, active surveillance is not for everyone. It’s strictly intended for low-risk prostate cancers, specifically grade 1 and some grade 2 cancers. But what does “grade” even mean when we’re talking about prostate cancer?

Prostate cancer is graded with a system called the Gleason score. It’s like assigning a grade to a student’s paper, except in this case, it’s cells and cancer we’re talking about. The Gleason score ranges from 1 to 5, with 1 being the lowest grade. For example, a Gleason score of 3+3 translates to a low-grade cancer.

But here’s the juicy nugget of information: grade group 1 prostate cancer is a whole new ball game compared to other cancers. Dr. Kevin Ginsburg, a urology aficionado from Wayne State University School of Medicine, explains, “There’s a wealth of literature showing that grade group 1 prostate cancer, in particular, is very, very different from other types of cancer. As a consequence of that, the harms of treatment often very frequently outweigh the benefits.” In other words, treatment might do more harm than good in these cases. Who would’ve thought?

Ginsburg, who also wears the hat of prostate program co-director at the esteemed Michigan Urological Surgery Improvement Collaborative, assures us that the risks of active surveillance are rather minuscule. He cites a study from Johns Hopkins, where they observed over 1,800 men and found that the risk of cancer death or metastasis was less than 1% over long-term follow-up. Phew, that’s a sigh of relief!

But let’s not forget the perks of active surveillance, shall we? By avoiding aggressive treatments, patients can spare themselves from the joys of incontinence or impotence. It’s all about maintaining that quality of life. And let’s be honest, prostate cancer is like a slow dance, perfect for monitoring. Take it slow, baby!

Cancer in Lowercase: The Prostate Cancer Revolution

Dr. Laurence Klotz, the prostate mastermind from the University of Toronto, is the hero who brought active surveillance to the world more than three decades ago. Back then, a staggering 95% of low-grade prostate cancer patients were seeking treatment. But boy, how the tables have turned!

Fast forward to the present, and active surveillance has become the go-to option for low-risk cancer. The number of men choosing active surveillance for prostate cancer has more than doubled nationwide between 2014 and 2021. Can you believe it? About 60% of eligible men are now happily embracing the non-interventionist path. That’s a significant jump from a mere 27% in 2014 and a meager 10% in 2010.

But the revolution doesn’t stop there, my friends. A recent study from Italy revealed that a whopping 83% of men prefer active surveillance over immediate treatment. And on top of that, prestigious organizations like the American Urological Association and the American Society for Radiation Oncology have strengthened their recommendation for active surveillance. It’s a stamp of approval!

However, Dr. Klotz believes that advanced technology might just be the bane of modern medicine. Such sophisticated tools can lead to overdiagnosis and overtreatment in various fields, including prostate cancer. “We’d be better off not even identifying this in the first place,” Klotz suggests confidently. After all, most prostate cancers are harmless, like a butterfly’s gentle flutter.

Dr. Michael Leapman, another one of the urology gurus from the Yale School of Medicine, reminds us that while PSA blood tests are fantastic at detecting early-stage prostate cancer, they aren’t exactly top-notch in distinguishing between aggressive and less worrisome tumors. It’s like they need a pair of glasses or something!

Believe it or not, some experts are pushing for a change in terminology. They argue that early, low-grade prostate tumors shouldn’t even be called “cancers” in the first place. It’s almost as if they are rebels with a cause — to redefine what it means to have prostate cancer.

For Dr. Daniel Lewis, an internal medicine doctor from the Facey Medical Group in Los Angeles, a patient’s decision to embark on active surveillance is influenced by their risk tolerance. When one of his patients receives a prostate cancer diagnosis and chooses active surveillance, he may even suggest getting a second opinion. It’s a moment of relief for many patients. No treatment? No problem!

Dying With, Not From, Prostate Cancer: A Personalized Journey

Partaking in active surveillance or stepping away from it altogether is a deeply personal decision. Many factors come into play, like quality of life, age, overall health, and life expectancy. It’s like navigating a maze with a blindfold on.

Some men gradually reduce their active surveillance efforts as they grow older, only opting for occasional PSA tests. Others bid farewell to surveillance entirely, choosing not to invest their time in something that is unlikely to be the cause of their demise. And then you have those who continue the surveillance journey for peace of mind, like a mind reader seeking certainty. But hey, some call it quits because, well, why not?

Ira Kaget, the fearless warrior, was diagnosed with low-level prostate cancer in 2009 at the age of 66. After the initial shock wore off, Kaget, now 80, did extensive research and consulted experts. With his mere 3+3 Gleason score and harrowing tales of treatment regret ringing in his ears, he embraced active surveillance. Every two years, he walks the tightrope of an MRI-informed targeted biopsy, accompanied by frequent PSA tests.

Today, almost 15 years later, with his condition showing minimal change, Kaget sees no reason to change course. “I plan to continue this journey, to keep monitoring, and I’m determined to manage my case,” Kaget enthusiastically declares. “The goal here is to die with it, not because of it.” A man on a mission!

So there you have it, folks, the daring adventure known as active surveillance for prostate cancer. It’s like tangoing with fate, embracing the uncertainty while keeping one eye on the disease. Whether you choose to dance along or sit out the performance, remember that it’s a personal decision. Each man must weigh the risks and rewards, listen to their body, and ultimately, live life on their own terms.

Now tell us, dear readers, have you or someone you know embarked on the active surveillance journey? Share your stories, thoughts, and pun-filled comments below. Let’s engage in this lively conversation together!