If you have localized, low-risk prostate cancer, you and your doctor may have decided that the best plan for you is active surveillance. You probably have many questions as to what that means. In this article, we will explain what active surveillance is and discuss what steps follow the decision of active surveillance.
What is Active Surveillance?
Active surveillance is a treatment plan that involves close monitoring of localized low-risk prostate cancer, rather than aggressive treatments such as surgery or radiation. Following this course of action means avoiding those treatments unless there are changes in your test results. If tests begin to show that your cancer is becoming more dangerous or growing, you may revisit more aggressive treatments.
For many men, active surveillance is the preferred choice for the initial management of low-risk prostate cancer. It can avoid the side effects or other health issues that can arise from cancer treatments. As many as 40-50% of men are now deciding to be treated by active surveillance.
One important keyword in active surveillance is “active.” This means you will need to follow a consistent plan that you and your urologist have agreed upon. Ensure you keep your doctor’s appointments to have your cancer checked out on a regular basis for many years.
What Follow Up Does Active Surveillance Involve?
During active surveillance, you will participate in specific exams and tests on a regular schedule decided by you and your healthcare team. These may include:
- Prostate-specific antigen (PSA) blood tests: Both cancerous and noncancerous tissue in the prostate produce the protein, PSA. A PSA test measures the amount of PSA in your blood. If your PSA level rises, it may mean your cancer is growing.
- Digital rectal exams (DRE): A DRE is a quick exam in which your doctor will examine your prostate gland by gently inserting a lubricated, gloved finger into your rectum. This exam allows your doctor to feel the surface of your prostate for bumps or changes. Your doctor can then assess whether the cancer has changed. At first, both PSA tests and DRE may be recommended by your healthcare team every 3 to 6 months. After several years, if things have been stable, your visits and testing may be done less often.
- Repeat prostate biopsy: A repeat prostate biopsy is usually recommended to be completed one year after active surveillance begins and may be repeated occasionally, per your healthcare team recommendations. This quick exam can take approximately 20 minutes.
- Magnetic resonance imaging (MRI) scans: Your healthcare team may decide to re-evaluate your prostate using a particular type of MRI. During an MRI, you will lie inside a machine that uses magnetic waves to create cross-sectional images of your prostate. This test will provide your healthcare team more information on the status of your prostate.
Are There Any Side-Effects to Active Surveillance?
Since you will not be having specific treatments, there will be no physical side effects. If your active surveillance plan includes prostate biopsies, be aware that there are some minor, short-term side effects from biopsies that typically resolve quickly.
A significant benefit of active surveillance is that it will not affect your everyday life as much as other treatments. Remember, if your results indicate that your cancer is changing, other treatments will be available to you.
Diet and Lifestyle Choices for Prostate Health
In addition to active monitoring, studies suggest that proper nutrition and an active lifestyle can improve your prostate health. Certain diet and lifestyle choices may be particularly beneficial for men going through active surveillance. Aim to eat at least five servings of vegetables and fruits each day to reap the benefits of the many vitamins, minerals, fiber, antioxidants, and phytochemicals (plant nutrients) found in these foods. Whole grains, legumes, and fatty fish are great daily choices as well. Add a few cups of green tea for extra benefit, and limit your intake of red meat and dairy. Maintaining a healthy weight and staying physically active are also important for prostate and overall health.
There is no universal agreement on how often you should have follow-up tests during active surveillance. It is important to note that you need to be willing and committed to attend regular follow-up doctor visits to monitor the status of your low-risk prostate cancer. Also, studies suggest that incorporating certain nutrients into your daily diet may be beneficial.
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