WHAT ARE THE FIVE SHADES OF BLUE?
Prostate cancer grows at a snail’s pace compared to other cancers. It’s such a common condition, it would be illogical to assume every case is deadly. PSA, Gleason score, imaging studies, and new genetic tests enable us to accurately identify a low-risk type of prostate cancer which is harmless. Active surveillance, close monitoring over time, is how we double check to confirm that the tumor is not misbehaving.
Ten years ago, surgery was called the “Gold Standard.” What changed? In 2012 The New England Journal of Medicine published a study by Dr. Timothy Wilt comparing the long-term outcome of surgery with observation. Survival between both groups was identical!
Most men who undergo surgery have long-lasting negative consequences. These men downplay their struggles, too embarrassed to talk about wearing a diaper or being impotent. Instead, they emphasize their gratefulness. They are “free from cancer.” But perhaps they are unaware that their life was never threatened. Dr. Wilt’s study confirmed that men undergoing surgery experience dramatically more side effects. Seventeen percent of men who had surgery compared to six percent of the men on observation had urinary dribbling, some losing larger amounts of urine, others having no control, and the remainder having an indwelling catheter. 81% who had surgery compared to 44% on observation had erectile dysfunction.
With active surveillance, appropriately-selected men can forgo immediate intervention, and in most cases, postpone destructive treatment indefinitely. The rationale for choosing active surveillance stands on the scientific validation of its safety, and the realization that sexual and urinary dysfunction from surgery or radiation is unacceptable.