Prostate Cancer Archive

Active surveillance and watchful waiting are the most conservative — and increasingly popular — approaches to prostate cancer management. Is one of these right for you?

Over the years, the outcome for prostate cancer has turned out to be better than expected for many men.

While prostate cancer is quite common, the risk of dying from the disease is low, even without treatment. In fact, most diagnosed men will die from something else, like heart disease. Even so, prostate cancer remains the second leading cause of cancer deaths (after lung cancer) in men, according to the American Cancer Society.

On call

Q. I've heard that calcium deposits can form in the prostate gland. What are they, and can they indicate cancer?

A. Calcium deposits can occur anywhere in the body; however, they often appear where there has been an injury, infection, or inflammation. Calcium deposits also can be seen with some types of cancer. When calcium deposits appear within the breast on a mammogram or in the lungs on a chest x-ray, their pattern helps the radiologist interpret the results. Certain patterns suggest possible cancer.

In the journals

Excess weight not only raises your risk of prostate cancer, it can also mean more aggressive and fatal cancer, according to a study published online June 10, 2019, by Cancer.

Scientists found that the accumulation of visceral fat (the hidden kind that lies deep in the abdomen and surrounds the major organs) and subcutaneous fat in the thighs (which lies just under the skin) were both associated with a greater chance of developing advanced prostate cancer as well as dying from the disease.

News briefs

New findings show a dramatic increase in the number of men taking a conservative approach to low-risk prostate cancer. According to a Harvard-led study published Feb. 19, 2019, in JAMA, use of active surveillance — which involves monitoring the cancer and delaying treatment unless it progresses — almost tripled from 2010 to 2015. The data come from the records of 165,000 men with prostate cancer. Researchers found that among men with low-risk prostate cancer (slow-growing cancer that's not considered life-threatening), active surveillance jumped from 15% in 2010 to 42% in 2015, surgery fell from 47% to 31%, and radiation dropped from 38% to 27%. Other studies also have also shown increasing rates of active surveillance in low-risk cases.

Why the shift? The authors point to national guidelines that now recommend active surveillance in such cases, as well as favorable research findings. "Emerging evidence has shown that active surveillance for low-risk prostate cancer is an effective alternative to surgery or radiation, associated with similar and excellent chances at long-term survival," notes Dr. Brandon Mahal, the study's lead author and a radiation oncologist with Harvard-affiliated Dana-Farber/Brigham and Women's Cancer Center.

Biomarkers are molecular signatures of both normal and abnormal processes in the body. Here is a more formal definition proposed by a "definitions" working group associated with the National Institutes of Health: "A characteristic that is objectively measured and evaluated as an indicator of normal biologic processes, pathogenic processes, or pharmacological responses to a therapeutic intervention."

Proteins, fragments of proteins, enzymes, DNA, the RNA molecules that "read" DNA—they all can serve as biomarkers. Blood is an ideal source material because it's easy to collect and examine, but biomarkers can also be found in other body fluids, like urine, and in tissue itself. Biomarkers can inform decisions before, during, and after treatment.

There's a lot you can do to improve your outcome if you're taking an active surveillance approach to your diagnosis.

 Image: © Nastasic/Getty Images

About 90% of men diagnosed with prostate cancer have the localized kind, which means the cancer is confined to the prostate gland. And for many, a reasonable approach is active surveillance, in which men choose to monitor their cancer instead of going straight into invasive treatments, such as surgery or radiation therapy.

Active surveillance includes a doctor visit about every six months, most often with a prostate-specific antigen (PSA) blood test and digital rectal exam.

On call

Q. I was recently diagnosed with prostate cancer. Does the occurrence of one type of cancer indicate a greater risk of developing other kinds?

A. Prostate cancer is the most common cancer among men, and almost every man will get prostate cancer if he lives long enough. In general, prostate cancer that develops after age 60 probably does not increase the risk of getting a different kind of cancer. However, there are some exceptions.

In the journals

 Image: © jarun011/Getty Images

The U.S. Preventive Services Task Force recently updated its guideline for prostate-specific antigen (PSA) screening for prostate cancer.

The group now recommends that for men ages 55 to 69, screening should be an individual choice, and a man should discuss the pros and cons with his doctor before making a decision. The report, published online May 8, 2018, by The Journal of the American Medical Association, differs from the 2012 guidelines that recommended against screening for all men.

In the journals

Only a biopsy can determine for certain whether prostate cancer is present, but a new study suggests that using magnetic resonance imaging (MRI) can help to better identify patients who are more likely to need a biopsy versus those who aren't.

The study, published online Feb. 22, 2018, by JAMA Oncology included 651 men screened for prostate cancer with blood tests and digital rectal exams. Everyone underwent three procedures: an MRI scan, a biopsy guided by transrectal ultrasound (TRUS), and a biopsy guided by both MRI and TRUS.

In the journals

Men with intermediate-risk prostate cancer may benefit more from a shorter duration of hypofractionated radiation therapy (HRT) than from standard radiation therapy. With both types of radiation therapy, the total amount of radiation is given in multiple sessions over a set period. Compared with standard radiation therapy, HRT uses larger doses over a shorter period of time.

A study in the Nov. 4, 2017, European Urology Focus analyzed data of 3,553 men with prostate cancer, 65% of whom had intermediate-risk prostate cancer. The men were randomized to get either a one-month program of HRT or the standard radiation treatment regimen given over two months. After an average of five to six years, the intermediate-risk men who had HRT were less likely than men who got standard radiation therapy to have their prostate cancer return.