Favoring Surveillance in Prostate Cancer Care
When it comes to certain cancers, doing a little, it turns out, can go a long way. Such is the experience of many men diagnosed with low-risk prostate cancer who are taking a more watchful approach to their disease instead of pursuing the traditional route of surgery, radiation, and chemotherapy. A recent article in Nature describes the approach, known as active surveillance, and features Hopkins inHealth patient advocate Bill Wilson.
Active surveillance, the use of which has quadrupled between 2000 and 2010, replaces treatment with the regular monitoring of patients with unaggressive tumors. This approach keeps the patient from undergoing unnecessary treatment that could result in urinary incontinence and erectile dysfunction. A key factor in the use of active surveillance is correctly distinguishing which patients have unaggressive tumors and, therefore, are eligible for participation. There is debate in the research community over the appropriate inclusion criteria; the active surveillance program at Johns Hopkins, led by Hopkins inHealth affiliate, Ballentine Carter, determines eligibility by examining prostate cells under the microscope and evaluating the results of digital rectal exams and needle biopsies. Another debate surrounding the use of active surveillance is determining when a patient should be moved to treatment if his tumor shows signs of aggression. At Hopkins, specific tests are performed once every six months to a year to monitor the tumor’s characteristics.
Despite the unresolved issues, recent studies have revealed that fewer than 2% of men with low-risk tumors died of prostate cancer within six to fifteen years after beginning active surveillance programs, comparable to the mortality rate of men with low-risk tumors who underwent surgery. As researchers, including those at Hopkins inHealth, work to improve active surveillance programs, it’s clear that the approach can have an enormous benefit on patient quality of life. As Bill Wilson put it, “A huge weight was lifted off my shoulders immediately.”