Options for low-risk prostate cancer patients include active surveillance, or watchful waiting, Dr. Bans says. Patients should also understand that biopsies may reveal only a portion of the cancer cells, so it is important to talk to a physician about further steps. Active surveillance also requires careful follow-up, regular exams, PSA tracking and repeat biopsies, Dr. Bans says.
Larry Bans: The answer, Jim, is currently there’s a lot of patients with low-risk prostate cancer which is considered slow growing and active surveillance, or what we used to call watchful waiting, is a common option for a lot of patients like yourself. There is of course some risk associated with active surveillance or watchful waiting, and that risk is that if the cancer does progress, or spread beyond the prostate cancer, it may extend to an incurable form of prostate cancer. That obviously is very unlikely, with a low PSA and what you were told, with a slow growing prostate cancer. When I read the question, I assume slow growing means you have a low Gleason score, and you have low volume disease, or not very much cancer in your biopsies. The one thing I want to make sure you understand is that the biopsy is just the tip of the iceberg in some cases; sometimes it picks up a small amount of malignancy and there may be more than that present, so I think talking to your doctor is the right thing to do. I think it’s certainly reasonable for people like yourself currently to be watched on an active surveillance protocol, but this will require careful follow up, examinations regularly, tracking PSA, and very likely doing repeat biopsies in the next year or two.