At the first ever Active Surveillance Convention, a conference I attended back in 2007, many experts openly bemoaned that the word “CANCER” profoundly overstates the significance of Gleason 6 type of prostate cancer. The pathologists at the conference, however, shot down the idea of a name change saying, “Under the microscope it looks like a cancer, so it is cancer.” No one at the conference had    a rebuttal so the proposal for a name change was dropped.

Back in 1996, I watched my steadfast father’s quality-of-life crumble as he descended into the world of prostate cancer (PC). Treatments (castration, radiation, etc.) rendered a once proud man a shadow of his former self, which was the result of gruesome side effects. Consequently, when I was diagnosed in 2005 at the age of 55...

AUA is an annual meeting of urologists where data from new studies are presented. This data is presented in abstracts, or summaries of the entire peer reviewed articles. In this article, Mark Scholz, MD, analyzes the data and explains the practical implications of these new studies.

Sunnybrook Health Sciences Centre’s Laurence Klotz, MD, speaks with PCRI about management of low-risk prostate cancer with Active Surveillance. 

What is active surveillance, and how does it compare with other methods of treating prostate cancer?

The concept of conservative management for prostate cancer is not new. In fact, in Scandinavia and England in the 70s, basically no one was treated until they had metastatic disease. And the idea was that treatment....

This summary is from the 2015 Prostate Cancer Conference where in his lecture, Matthew Cooperberg, MD, spoke on Active Surveillance. Dr. Cooperberghas has been invited to present his research findings at many national and international conferences. 

Eight years ago, at the age of 55, I learned I had prostate cancer. At that time, ignoring three separate doctors’ recommendations, I decided to forego surgery. One of my doctors, a urologist, gave me the name of a patient who was on active surveillance. I contacted Brad Cole and our conversation gave me the courage to try it myself.

All this not withstanding, in my mind there is no doubt that Testosterone Inactivating Pharmaceuticals (TIP), when appropriate and applied in a timely manner, acts effectively to control prostate cancer.

The surprising finding, after 12 years, was that there was no difference in survival between surgery and watchful waiting in the Low-Risk or in the Intermediate-Risk group.  On the other hand, men who were in the High-Risk category did benefit with improved 12-year survival when treated with immediate surgery compared to the men with High-Risk disease who did watchful waiting. 

In May 2011, the New England Journal of Medicine reported on 695 men from Sweden, Finland, and Iceland, average age 65, who were randomly allocated to either immediate surgery or delayed hormone therapy (DHT) between 1989 and 1999.  The median PSA for the 695 men was 13. Eighty percent of the men had palpable disease found during their digital rectal exam. In the men treated with DHT, hormone therapy was initiated if and when bone metastasis occurred. Bone scans were performed every other year. 

More and more men are embarking on active surveillance—close monitoring of their prostate cancer—rather than implementing immediate radical therapy. Of course, only individuals with carefully selected low-grade prostate cancer are eligible for this approach. During the extended observation period many men enquire if there are nontoxic interventions to improve their odds that the cancer will stay dormant. The important issue of diet often arises though that is not the subject of today’s topic. Hormonal treatment, on the other hand, is a treatment that calls for further discussion.