“I’ve introduced a lot of people into active surveillance. They have to meet certain criteria. They have to be followed very carefully. Ten to twenty percent of those people will progress unexpectedly and have a less than favorable outcome, but that’s not going to change how I practice.
If they meet the criteria for active surveillance, I actively try to persuade them to do that. If they don’t feel comfortable, obviously I offer robotic prostatectomy or radiation therapy.
I would say two-thirds of men are willing to try active surveillance, but at least a third are not comfortable; they just want the cancer out. They don’t want to have to come back for a PSA three or four times a year and repeat biopsies every 1 to 2 years. There is a commitment that goes into that. When you look at robotic prostatectomy or brachytherapy, they’re both relatively easy treatments to go through with good results. Particularly younger guys may not want to do active surveillance. There’s some logic to that because eventually in 10, 20 years, they are likely to progress and need treatment later anyway.”
Gregory McCoy, MD