What to do if diagnosed with "low risk" prostate cancer

As much as half of all diagnosed prostate cancer is low risk, meaning it's nonlethal and growing very slowly, if at all, and may be something you can live with, depending on your age and health. Yet most men, once they hear they have prostate cancer, want to get rid of it and often decide on an aggressive treatment such as surgery or radiation. As a result, they risk some potentially nasty side effects -- i.e., varying degrees of incontinence and impotence. Unfortunately, there is no single test that can clearly differentiate between low risk and high risk or aggressive prostate cancer. 

In deciding what you should do if diagnosed with prostate cancer, here is criteria that the Brady Urological Institute at John Hopkins Medicine has published on its website, in an article entitled "Active Surveillance for Prostate Cancer: What A Man Needs to Know Before Deciding on Treatment."

Use this information as a guide in discussing options with your doctor and please visit JHM's website for more information. 

Eligible men (for Active Surveillance) should meet the following criteria for Very Low or Low Risk Disease:

Very Low Risk Prostate Cancer

• Life expectancy less than 20 years
• Cancer not felt on digital rectal examination (stage T1c)
• PSA density (PSA divided by prostate volume) is less than 0.15
• Gleason score is 6 or less with no Gleason pattern 4 or 5
• No more than 2 cores with cancer, or cancer involving no more than 50% of any core on at least a 12 core biopsy

Low Risk Prostate Cancer

• Life expectancy less than 10-15 years
• Cancer not felt on digital rectal examination and/or small nodule (stage T1c or T2a)
• PSA below 10ng/ml
• Gleason score is 6 or less with no Gleason pattern 4 or 5 on at least a 12 core biopsy

How does a man who qualifies for surveillance make a choice between active surveillance and treatment?

At the Brady Urological Institute we do not encourage healthy men in their 50’s to strongly consider active surveillance because of their longer life expectancy and time horizon for cancer progression. For older men, especially over age 65 years who meet criteria, active surveillance is one of the options that should be seriously considered.
 
In a recent study with colleagues in the Bloomberg School of Public Health, we evaluated the factors that influenced a decision regarding active surveillance versus surgery using a computer simulation (Markov model). The men best suited for surveillance would appear to be those that:

• have the ability to live with cancer without worry reducing their quality of life
• are most concerned about the potential side effects of treatments
• value near term quality of life to a greater extent than any long term consequences that could occur

Each man should carefully weigh the potential loss of quality of life with treatment (radiation or surgery), against the possibility that the window of opportunity for cure will disappear without treatment.