As a radiation oncologist, I see many men with newly diagnosed prostate cancer who understandably are interested in Observation or Active Surveillance.
Active Surveillance is a great option if you and your doctor are certain that you meet all criteria and there is minimal concern for the prostate cancer spreading outside the prostate, or to the lymph nodes or bones. Typically, your PSA is <10 ng/mL and your biopsy result showed very little cancer and what was there, was low grade.
Here are 3 things you need to know from your urologist or oncologist prior to choosing Active Surveillance over treatment with surgery or radiation.
1. What is your Gleason Score?
For Active Surveillance to be considered, we recommend the Gleason score be 3+3=6. Gleason 6 disease is expected to be slow growing and not aggressive. This means that your physician does not expect it to spread quickly and cause problems.
Note: some men with Gleason 7 prostate cancer can consider active surveillance, however other factors are considered, such as how much cancer is in the prostate.
2. What are the results of your multiparametric MRI?
Ideally a mpMRI was done PRIOR to your biopsy and if you are fortunate enough to live near a larger hospital, your Urologist may have done a targeted MRI fusion biopsy. Regardless, if you are considering Active Surveillance, a ‘multiparametric’ MRI is recommended. (Note: ensure it is “multiparametric” and not just a regular pelvic MRI)
Remember that a standard TRUS biopsy (trans-rectal ultrasound guided) samples tissue from both sides of the prostate gland. Typically, the Urologist will take 6 samples from each side for a total of 12. The pathology report then shows if there was prostate cancer present and gives the Gleason Score.
However, what if the biopsy missed some Gleason 7 cancer? Or even worse, what if the biopsy didn’t pick up more aggressive disease such as Gleason 8, 9, or 10? While this is unlikely if the PSA is < 10 ng/mL, it is important to confirm the accuracy of the biopsy.
A mpMRI can actually detect Gleason 7 or higher cancer in the prostate gland. The mpMRI also confirms if all the cancer is confined to the prostate gland or there is concern for cancer “bulging” against the edge or capsule of the prostate which can indicate some cancer cells could be outside of the prostate and consequently need more aggressive treatment.
3. What are the results of your genomic testing (Decipher, Prolaris, Oncotype DX)?
These genomic tests are recommended for men with Gleason 7 disease and can be considered in Gleason 6 disease to help guide the decision for Active Surveillance vs treatment with surgery or radiation. These tests examine the expression of specific genes in your prostate cancer tissue (obtained during your biopsy) and provide a score. The score typically confirms whether the risk of the prostate cancer spreading to other organs and causing death is Low, Intermediate, or High (there’s some variability on reporting between the different tests).
These tests are valuable and worth considering as they examine your specific cancer and predict how it is expected to progress over time.
Patient-focused treatment, and an individualized approach to oncology means Dr. Norleena Gullett is not just treating cancer, she's treating the whole person.