What Are Doctors Monitoring During Active Prostate Cancer Surveillance?

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In some cases, prostate cancer patients are put on active surveillance after diagnosis and don’t require immediate treatment for their cancer. What is the protocol for patients on active surveillance? Prostate cancer expert Dr. Maha Hussain, from the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, explains who is put on active surveillance and why, how patients are evaluated and the plan for follow-up care. Adult nurse practitioner Brenda Martone weighs in with her take on the patient role in active surveillance. Tune in to find out more.

This is a Patient Empowerment Network program produced by Patient Power in partnership with Robert H. Lurie Comprehensive Cancer Center of Northwestern University. We thank Astellas, Clovis Oncology and Pfizer for their support.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Let’s start with, what I think you call active surveillance. What are the qualities, the analysis going where you say to a gentleman, we can do active surveillance, and what does that entail, and then whether or not surgery would be indicated, and-or radiation, and then, do we need to do systemic therapy?

Dr. Hussain:         
Sure. Let’s begin with a hypothetical case. A person comes in for one reason or another, they end up either having a symptom or even without a symptom they go for their routine follow up with their primary care doctor and the PSA is done. That PSA is done and let’s say it comes back as five. That is monitored and at a next time it’s evaluated, the number is the same or slightly higher. At that point, the patient is referred to a urologist. 

The urologist will start the evaluation and part of the evaluation right now, we have, also, integration of MRI to evaluate the prostate that will give better views of where things need to be done and the size of the prostate, and the potential risk in there based on the morphology, and so on. At the end of the day, the definite confirmation of presence of cancer is gonna be driven by biopsies. Let’s say the biopsy is done and then this tissue is evaluated, and the pathologist comes back with a Gleason 6, let’s say. A Gleason 6 prostate cancer is deemed to be, generally, a non-aggressive cancer.

Assuming the patient on evaluation, again, by the urologist and the MRI, there is not a concerning lesion in the prostate, meaning it’s too large or some tumor, or something else that is of concern more so then what the Gleason is showing, and assuming by all other criteria the patient is in good health, compliant, is gonna come back, then usually a process is put in place. Generally, this happens with the urologist where there is routine monitoring of the PSA of the prostate and periodic biopsies are done, again, depending on either for a cause, and it’s not for a cause, as part of routine evaluation. 

This is something that was implemented primarily to minimize the risk of unnecessary treatment because—or doing radiation treatment or so on can leave the patient with residual side effects from those treatments, when, in fact, in the first place, that cancer may not be – ever been harmful and they could have died decades later from something else. 

That’s generally the routine, and I generally advise my patients who come in, let’s say, for a second opinion to actually consult with their urologists, have a routine follow-up, and never assume that the history is gonna predict the future, which means there are times when patients in follow up, either their PSA goes back up or they develop a mass in their prostate that’s more palpable, or the—on a follow up biopsy, the score goes up, at which point the patient needs treatment. Really compliance becomes a critical part of the process.

Andrew Schorr:
Okay, so it’s a team, and I want to introduce someone else who’s part of your team. I think this is a good place to do it. That is a nurse practitioner who works with you, with prostate cancer patients, and that’s Brenda Martone. Brenda is a very regular part of your team. Hi, Brenda, thank you for joining us.

Brenda Martone:                
Hi, Andrew. Thank you very much for having me.

Andrew Schorr:
Brenda, when somebody is in active surveillance, they’ve got to be communicating with their doctor, right, and then there’s a certain routine that Dr. Hussain just talked about, maybe some repeat biopsies with some frequency, monitoring the PSA. When you talk to patients, you have to say, we’re in partnership, right?

Brenda Martone:                
Absolutely. We can’t do this by ourselves and we need to make sure the patient understands what their responsibilities are, and then we need to make sure that we follow up with them if they do get a little bit lost, so we can continue the process and the act of surveillance. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on January 29, 2019