IS ACTIVE SURVEILLANCE (WATCHFUL WAITING) ADVISABLE FOR YOUNGER MEN DIAGNOSED WITH PROSTATE CANCER?

September 6, 2018 1:19 pm Published by

“After undergoing a biopsy, Dr. Robert Pugach explained treatment options ranging from watchful waiting to HIFU.  Even though my prostate cancer was in the early stages, I decided to be treated with HIFU. I’m not the type of man that can wait and watch. My HIFU procedure was performed in June of 2014.   I’m very thankful that I was in the hands of one of the most experienced HIFU Doctors in the country. Also, I thank the HIFU Prostate Services team, and a HIFU patient that I spoke with, (who is now a good friend) for guiding me through the entire procedure.  I’m a strong advocate for prostate cancer screening and will do all I can to help educate men about HIFU.” Tony, age 61

Prostate cancer is commonly viewed as a disease affecting older men. But is this true?  Recent studies are challenging this belief as there has been an increase in the incidence of prostate cancer in young males. In fact, 10% of new prostate cancer diagnosis in the United States occur in men who are under 55 years old.

A study published in Current Urology (Curr Urol. 2017 Jan; 9(4): 212–215) “demonstrates that prostate cancer is not only ‘disease of old age’, as believed earlier, and should be kept as differential when treating young males for lower urinary tract symptoms.”

The authors of this article cite the following important take-home points:

  1. With changing environmental factors and PSA screening, a larger number and proportion of young males with prostate cancer are coming into attention.
  2. Most young patients with prostate cancer have moderately differentiated organ-confined disease.
  3. Given the otherwise longer life expectancy in younger patients, treatment should be initiated promptly rather than using the wait and watch method generally used in older age group males.

While some urologists may argue that the increased incidence may be due to more prevalent screening, there are still reasons to be very concerned.  For many years, there has been a movement to not treat all prostate cancers. The reason is that there are men whose cancer will never grow to the point where it will metastasize (spread to other parts of the body) or cause death. The movement to not treat has now expanded to not even diagnosing prostate cancer. The result is that there are now potentially millions of men with prostate cancer who either don’t know they have it or are allowing it to grow and spread.

The result is an alarming rise in the number of men with advanced, metastatic prostate cancer and a 20% increase in prostate cancer deaths.  This is due to a decrease in annual screening for prostate cancer and failure to initiate prompt treatment at the time of diagnosis. It is important to remember that prostate cancer is CANCER.  It is not necessarily a slow-growing tumor located in the prostate. It has the potential to spread locally and obstruct the kidneys. It can grow into the bladder and cause significant bleeding. It may spread to other areas. The most common site of metastasis is to the bones where metastases are extremely painful. If it spreads to the vertebra that surrounds the spinal cord paralysis can result. Once again, prostate cancer is CANCER!

What advice do I give my patients?  The same advice I followed when my PSA was abnormal.  I had a biopsy that showed cancer and I was treated promptly.  More than one year later my cancer is gone and I have no side effects from my HIFU treatment.  I chose early treatment over watchful waiting (surveillance) because I didn’t want to watch my cancer grow.

Read more about The Case Against Active Surveillance.

Categorized in: Categorized in:

This post was written by Western States HIFU

A Message from Dr. Pugach Regarding Coronavirus (COVID-19)