Prostate Cancer: Surveillance or Surgery?

MIAMI, Fla. (Ivanhoe Newswire) -- More and more men with prostate cancer are choosing not to have any treatment at all. In the past, these men often did what's called watchful waiting -- simply waiting for something to happen with the cancer before taking any active measures. Now, many men are taking a more proactive approach while still saying no to treatment.

One doctor has a message he wants every man with prostate cancer to hear. "We are finding these cancers smaller and smaller, and we know for sure that many of them would never need treatment in their lifetime,“ Mark Soloway, M.D.,
urologic oncologist at the University of Miami Sylvester Cancer Center in Miami, Florida told Ivanhoe.

In fact, one report estimated about 25 percent of the men treated for prostate cancer do not benefit from the therapies. Doctor Soloway says a plan called "active surveillance" may be the best bet. It is not watchful waiting. Active surveillance requires a rectal exam and PSA every four months -- a biopsy once a year. No surgery, no radiation, no treatment. It's not for everyone. 

"I wasn't too happy about something growing every second of the day within me,“ prostate cancer survivor Ramesh Krishnaiyer told Ivanhoe.

So Krishnaiyer chose surgery. It had risks but eased his fear. "Sooner, the better,“ Krishnaiyer  said. “I needed to get it out."

For Terry Johnson, making it big with his group the flamingos was easy compared to hearing he had cancer. "It was just a frightful thing to hear: Cancer!“ Johnson exclaimed.

He was ready to undergo an experimental treatment when he met doctor Soloway. "He said, 'You will not die from this prostate cancer. It's not large enough,'“ Johnson recalled.

So he had no treatment, and instead chose active surveillance. It's been so far, so good after one year. Soloway is following about 200 men on active surveillance. He says some will eventually need to be treated, but not many.
"Only about 12 percent of the men have been treated,“ Soloway explained.  “Eighty-eight percent have had no treatment yet."

It is a careful approach that's a welcome option for some. Doctor Soloway says candidates for active surveillance need to have a PSA below 10 and a gleason score that falls within a specific range. According to the American Cancer Society, some early studies have shown men who choose active surveillance and go on to be treated do just as well as those who start treatment right away.