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Prostate Cancer Treatment: Will a New Scientific Finding Make "Watchful Waiting" (aka, "Active Surveilance") More Viable?

Posted Oct 04 2009 7:00pm
Prostate Cancer treatment, as urologists currently acknowledge, tends to be aggressive following diagnosis. Half of nearly 200,000 patients each year opts for surgery (primarily robotics), and the remainder generally chooses some form of radiotherapy. Relatively few select High Intensity Frequency Ultrasound (HIFU) or cryotherapy, which respectively seek to use hot or freezing temperatures to eradicate a man’s tumor. 

As for the 10 to 20 percent of new patients whose cancer is first diagnosed when it has already metastasized, the prostate cancer treatment of choice is chemotherapy, hormone therapy, Provigil, radiotherapy or a combination of such prostate cancer treatments. 

Some urologists and family practice physicians recommend less aggressive prostate cancer treatment. Their treatment plans include monitored "watchful waiting", aka, “active surveillance.” Until now this approach has been regarded as a shot in the dark, since scientists haven't developed a way to determine if and when a man’s tumor that's contained in his prostate is likely to metastasize. 

As such, if you select a more aggressive prostate cancer treatment after speaking with your urologist or oncologist, you can breathe more easily. Having your prostate removed or irradiated is simply the most straightforward way to assure you that your prostate cancer will not spread to your bones or organs surrounding your prostate. 

Now, following a 15-year study of 553 men, British scientists have concluded that a new biomarker may be available to determine how aggressive a self-contained tumor may become. They determined that among those whose blood contained traces of a protein called HSP-27 when first diagnosed, twice as many were likely to develop an aggressive form of prostate cancer. The implication is that HSP-27 may prove to be a valuable biomarker predicting if a man diagnosed at an early stage is likely to get worse over time.

Frankly, as I've implied, the only reason active surveillance is not a more frequently selected prostate cancer treatment is we don't know if the cancer will remain slow-growing or if it will metastasize in the absence of more radical prostate cancer treatment. Hopefully the HSP-27 study will be duplicated by other scientists to confirm that it's a good predictor of potentially aggressive prostate cancer. Such a development may help doctors to reduce the prospect of excessive prostate cancer treatment with its various adverse side effects.

Only if HSP-27 is consistently proven to be a good predictor of metastasis will scientists be more certain that they can recommend active surveillance as the best initial prostate cancer treatment approach. Until more studies are completed, though, it is still true that there's no way we can definitively determine if a usually slow-growing prostate cancer tumor is likely to suddenly grow more quickly. 

So what's the upshot, despite the new tentative scientific finding that this biomarker may help determine whose cancer is likely to spread? In my view it may still be prudent NOT to select active surveillance, when you or someone you know is first diagnosed with prostate cancer. I certainly can vouch that I would want more definitive proof that I could afford to wait and see what might happen, rather than choosing more aggressive prostate cancer treatment. That is why I chose robotic surgery in April 2007, just three months after I found out that I had prostate cancer.

The new finding about HSP-27 has not reduced my conviction that early stage prostate cancer should be treated by more invasive prostate cancer treatment, including surgery or radiation. Despite this new effort at discovering which tumors are more aggressive, for now there is only one thing to do: take active action! The only way we can be sure about  eradicating what may become a more aggressive prostate cancer is to be more proactive in selecting a relatively more aggressive  prostate cancer treatment. 

I'm aware that some urologists and oncologists who favor active surveillance have some valid arguments to support their point of view. For instance they point out that at most 3% of men diagnosed with early stage prostate cancer who are not aggressively treated or eliminated, will eventually end up with advanced cancer. 

But what will happen to a man who waits and finds out he's one of those 3 percent?  The end result can be extremely painful. Besides, two-thirds of advanced cancer patients will die within five years, whereas 99% of those whose prostate cancer is discovered early and treated more aggressively within months of a diagnosis, are likely to be alive five years later. 

All this is points to one conclusion: I continue to argue for more deliberate, aggressive treatment even when a less threatening form of prostate cancer is first discovered. I feel strongly about this despite the low odds of dying so quickly from a prostate cancer treatment when applying the prostate cancer treatment of  active surveillance. 

Quite simply, I am not a betting man. As such I would not want to take a chance on choosing active surveillance even under the watchful eye of the most vigilant doctor. Given the possibility, - however remote, that I might end up among the 3% whose cancer advances, I would not like to see my life come to an end prematurely. 

None of us is a mere cipher to ignore possible death due to a more low-key prostate cancer treatment choice, especially since more active approaches are available to us. I believe in the truth of the old cliche that we should "strike when the iron's hot."

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