Prostate cancer is the most common cancer in American men, with one in eight being diagnosed with the disease at some point in their lives. At the same time, 90% of men who have prostate cancer will live on because the cancer remains localized and does not spread to other parts of the body. They will ultimately die of something else. This is defined as low-risk prostate cancer.

In the case of a 65-year-old patient with this diagnosis, for example, what would be the best medical approach?

Dr. Mohummad Minhaj Siddiqui, the director of urology for the VA Maryland Health Care System, is a major advocate of active surveillance. That means instead of opting for surgery to remove the prostate or radiation to zap the cancerous cells, properly selected patients would follow a series of monitoring procedures. They include blood tests to check the PSA (prostate specific antigen) score; MRIs (magnetic resonance imaging); digital rectal exams; and biopsies in which doctors examine prostate cells for signs of disease progression. Plus, new genomic tests are available to help doctors prescribe the best-targeted medication.

`Uncomfortable with the thought’

While active surveillance sounds like a logical approach for men with low-risk prostate cancer, especially given that prostate removal and radiotherapy can lead to urinary, bowel and sexual dysfunction, convincing patients to buy into it can be a challenge all its own.

“Fundamentally, many people are uncomfortable with the thought that they’ve been told they have cancer, but that they’re not going to do anything about it,” says Siddiqui, who is also an associate professor of surgery at the University of Maryland. “It takes a lot of explanation and coaching to make someone comfortable with it. Some people will never be comfortable with it. Active surveillance is not the same as ignoring the cancer or walking away from it. It’s a very engaged proactive process where you are closely monitoring the person.”

Over the past 15 years, active surveillance has become a popular practice in the medical community in cases of low-risk prostate cancer. Many men in that grouping have a PSA score of less than 10 and a Gleason score of six or less. A PSA score is like an alert that someone needs to be checked out. A Gleason score, which is calculated through a biopsy, predicts the aggressiveness of prostate cancer.

Many men with low-risk prostate cancer opt for treatment

Active surveillance is often recommended as a first-line treatment in various guidelines to avoid overtreatment and complications with surgery and radiation. The National Comprehensive Cancer Network, a non-profit alliance of 31 leading cancer centers devoted to patient care, research and education, recently reversed itself with new guideline language restoring active surveillance as a preferred approach for most men with low-risk prostate cancer.

Yet, almost half of men diagnosed with low-risk prostate cancer opt for immediate treatment, a rate much higher in the U.S. than in other parts of the world, according to Siddiqui. In addition to the skittishness patients may feel about living with the cancer, financial and legal pressures sometimes influence clinicians in the United States to recommend surgery, radiation or some other form of treatment, he says.

“There’s a mix of things that come into play,” Siddiqui says. “It’s important to remember that the practice of medicine is evolving, and even though today we are strongly advocating for active surveillance, that doesn’t mean that was the practice 5 to 10 years ago. The field is trying to push the envelope a little bit on who you can do [active surveillance] on, but that’s not the way it was before. Before, you were typically trying to be more conservative. So someone who’s been practicing medicine for 20 years and may not be in an academic environment may not be day-to-day in adapting to the newest changes.”

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By Mike Richman is the managing editor in VA Research Communications

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Published on Mar. 15, 2022

Estimated reading time is 3.3 min.

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  1. Mary Toon March 22, 2022 at 8:43 am

    Any comments for person’s with prostate cancer who suffer from leakage. Is there a hope to resolve this, or will a person have this for the rest of their life. I know a wonderful person who suffers from this. Yes thank God they are amongst us still, but it is an issue that I hope they can overcome for obvious reasons. Thank you and God Bless those who are fighting this fight.

  2. Ernie Howe March 18, 2022 at 8:51 pm

    You believe that I have some one Ean front property in AZ I’ll sell you! VA is a killing machine, run by 2nd & 3rd rate doctors who can’t make it in the REAL WORLD!

  3. Ernie Howe March 18, 2022 at 8:49 pm

    Or go to a REAL DOCTOR in the civilian sector! You know, a doctor that keeps your business thru honesty, integrity & professionalism instead of a 2nd or 3rd rate doctors who can’t make it in the REAL WORLD, so they hide their incapabilities under the govt umbrella where they can kill you & it’s no problem for them! Like the Indiana VA doctor who according to the VA IG in DC, “BOTCHED” 147 Orthopedic surgeries & instead of firing him like any normal employee that made 147 MISTAKES would be, not at the VA! Nope they gave that incapable doctor probation! And that doesn’t even factor in the pain & suffering those vets have to live with! Best Care Available, my *ss!!! We are no more than guinea pigs & objects used to keep this out of control, govt run so called Healthcare system afloat! If this is an example of govt run Healthcare, YOU DON’T WANT IT AMERICA!
    Took a picture of this one too as I expect this will be deleted!

    [Editor: Recovered from the spam folder. Please do not type in all caps. ]

  4. Joe Georges March 17, 2022 at 12:58 pm

    While we are on the subject of Prostate Cancer just wondering if anyone exposed to agent orange in the military had the experience of getting diagnosed with BPH at an early age. I was diagnosed at 40. Just wondering if there were any numbers that show the number of military folks exposed to agent orange that got BPH.

  5. Michael Loewenthal March 16, 2022 at 10:40 am

    Over the years of care from the VA I have various recommendations based on the position of the VA at the time. Providing this article to all primary care doc’s at the VA and in publications of all kinds would go a long way to inform the medical and laypersons.

    Looking forward to future follow-up.

  6. Gary Tuttle March 15, 2022 at 6:00 pm

    My Doctor’s comment some 10-15 years ago after my initial diagnosis and now every year since during my yearly exam was, and still is
    “watchful waiting. And I still am and at 86 yrs. plan on many more.

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