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.
Nutrients for Prostate Health
In addition to active monitoring, studies suggest that proper nutrition and an active lifestyle can improve your prostate health. Certain foods and nutrients may be particularly beneficial for men going through active surveillance.
Vitamin D is a fat-soluble vitamin that has many health benefits for men including an essential role in prostate health. Those with vitamin D deficiency may be more likely to have more aggressive prostate cancer. One study concluded that 2,000 IU of vitamin D a day resulted in a decrease in the rate of PSA rise. We get vitamin D through sunlight, from food, or by taking a vitamin D supplement. It is difficult for most people to get enough from diet alone, as few foods are rich in vitamin D. For this reason, many people will need to take a vitamin D supplement to achieve an adequate level.
Lycopene is a carotenoid, or plant pigment, that gives tomatoes their bright red color. It is also a powerful antioxidant in our body. A recent study found a signiﬁcant inverse association between lycopene and prostate cancer risk. Other studies have shown that 30 mg of lycopene a day from tomato products decreases PSA in men with localized prostate cancer. Tomatoes are a rich source of lycopene, but it is also present in pink and red grapefruit, guava and watermelon. Interestingly, cooked tomatoes provide more lycopene than raw tomatoes.
Soy isoflavones are known as phytoestrogens or plant estrogens. Studies suggest these compounds may decrease the growth of prostate cancer cells, and in men being treated for prostate cancer, may decrease the rise of PSA rise. Although it is not clear exactly how soy isoflavones work against prostate cancer, they are thought to have antioxidant and hormonal properties, and decrease growth and spread of prostate cancer cells. Soybeans and soy products such as tofu, tempeh, and miso are rich-sources of isoflavones. Supplements made from a whole soybean extract, containing soy isoflavones, are also available.
Green tea contains antioxidants called catechin polyphenols, which may decrease the risk of certain cancers. One review concluded that drinking green tea reduced the risk of prostate cancer and suggested, the higher the intake the more benefit. Another review found that evidence is lacking for green tea and prostate cancer progression. Therefore, you may want to consider drinking green tea for its potential prostate health benefits.
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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