Active surveillance (AS) continues to be one of the more popular options for managing prostate cancer. Statistics in JAMA found that the number of men with low-risk prostate cancer who chose AS over other treatments rose from 14.5 percent to 42.1 percent between 2010 and 2015.
Yet, some men may not take full advantage of its benefits. Aversion to AS is likely due to fear and anxiety.
Does Active Surveillance mean no treatment for Prostate Cancer?
AS means you don’t begin any therapy right away. Instead, you monitor your prostatic specific antigen (PSA) levels for changes. This approach helps avoid or delay the need for biopsies and/or treatments until they may be necessary.
During AS, your PSA levels are tested at least once every six months. You also have an annual digital rectal exam (DRE). If your PSA level rises, your doctor will likely recommend a prostate biopsy with a follow-up biopsy after 18 months.
The main benefit with AS is that you avoid jumping straight into invasive and painful biopsies or undergoing aggressive treatments with possible side effects like erectile dysfunction and urinary problems.
But for AS to be useful, you have to be diligent about routine follow-ups, and that is where many men fall off the AS wagon.
If you are on Active Surveillance You Must Follow up with your Physician.
A new study, presented at the 2019 American Society of Clinical Oncology Meeting, found that only about 15 percent of men who chose AS actually follow through on regular monitoring practices.
In the study, 346 men with low- or intermediate-risk prostate cancer were followed for two years to see how often they complied with PSA testing, DRE exams, and follow-up biopsies.
It turns out that the men were good about PSA testing for the first six months, but that the commitment dropped off over time. DRE rates were steady, but biopsy rates were poor almost from the get-go and continued to fall over the two years.
Fear and Anxiety is the Main Reason why Men Get Off Active Surveillance for Prostate Cancer
Another interesting finding: after two years of AS, many men switched to active treatment.
Why did they give up AS? Too much anxiety suggested the researchers.
The psychological part of AS perhaps is its main downside—the worry, stress, and fear that something could be wrong is often difficult to bear for many men.
You have to wait-and-see if you do have high-risk cancer and need more serious treatment, and the idea of walking around with that uncertainty can be overwhelming. So men give up too early and go straight to a biopsy and possible treatment or surgery if needed.
Lifestyle Medicine is Doing Something for Prostate Cancer while on Active Surveillance
My take is that AS is a smart and reasonable approach for many men. It helps them step back and take a deep breath. They can better analyze their situation and make lifestyle changes, like revamping their diet and exercise, which can improve their outcome.
But I agree that you need the right personality for AS to be most effective. If you are a type-A personality who is impatient and driven by a sense of urgency, then AS may not be right for you. Plus, even if you are okay with the concept of AS, you may be pressured to do more about your prostate cancer from family and friends.
Keep in mind that AS is a pro-active method for prostate cancer management and that lifestyle and behavioral modifications are too medicine.
In other words, what and when you eat, exercise for four to six hours a week, optimizing sleep and targeted dietary supplements likely help men on AS reduce the chances of needing aggressive treatment.
A slow, systematic approach to monitoring your condition might be the best choice, at least in the short term.
Just because you are not doing anything, doesn’t mean you are not doing anything.
Lifestyle and nutrition methods IS doing something while on AS – It is being Pro-Active.
Resources that may help:
Video on the CaPLESS Method – a detailed lifestyle approach for men with prostate cancer.[Disclosure: I, Dr. Geo am co-founder and formulator of dietary supplements for XY Wellness]