Speak Out: What's your comfort level with active surveillance for low-risk prostate cancer?

March 1, 2013

Urologists share how confident they feel about active surveillance for low-risk prostate cancer.

“I’m actually very comfortable with it and have been treating patients that way for years because I trained under Dr. Ballentine Carter at Johns Hopkins, who was one of the first to develop active surveillance protocols.

He and pathologist Dr. Jonathan Epstein defined what we consider minimal disease.
In the early ‘90s, we started observing the lowest risk patients. Fifteen years later, because it worked so well, we’re observing people with a little more disease. These are people who will not die of prostate cancer, and we follow them carefully to make sure we’re not wrong, especially men in their 50s.
The risk people face of potentially missing the window of opportunity for treatment is no greater than the risks of undergoing treatment.”
Stephen Jackman, MD
Pittsburgh

“I’m fairly comfortable using it with select patients if they have a Gleason 6 or lower, three or fewer positive biopsies, a PSA less than 10.0 ng/mL, and they agree to a follow-up biopsy in 9 to 12 months and frequent PSAs.
This is a change for me. At first, I was a bit nervous, but more information has come out that Gleason 6 is not necessarily a bad cancer. People with a Gleason 6 do well, and a lot of people with Gleason 6 are overtreated.
For the most part, patients are hesitant; they hear the word ‘cancer’ and get nervous. I’ve had patients who have started out on active surveillance and opted to go for some kind of treatment. It will take some patients a while to feel comfortable with this.”
Stephen Jackson, MD
Cleveland, TN

“I’m very comfortable. With the criteria that have been set up, I’m actually encouraging a good portion of my patients with low-grade Gleason 6, low PSA, and one or two core-positives to go on active surveillance.
I’m more aggressive with active surveillance than I used to be. I’ve only been in practice 4 years. But I’ve become more comfortable because the patients I have on it are doing well and their cancer isn’t progressing. I do keep a very short leash on them, with frequent PSAs. So far, I haven’t converted anyone off active surveillance.
I used to worry about the psychological impact of [surveillance], but with the right counseling, most of these guys are very happy with their decision.

A lot of men now come in a little skeptical about PSA because of the publicity, so they’re prepared for the discussion. I talk about it before doing the PSA, so it doesn’t come out of left field.”
Scott Kalinowski, MD

Phoenix