Monitoring prostate cancer

Monitoring means keeping a close eye on you medically. You don't have any treatment straight away. Your doctor monitors you with regular tests, to see whether the prostate cancer is staying the same or starting to grow. You can start treatment straight away if there is any sign that your cancer is beginning to change or grow.

Your doctor may call monitoring prostate cancer active surveillance or watchful waiting. Some doctors use these terms to mean the same thing. But they are actually used in different situations. So we have covered them separately on this page.

Prostate cancer specialists use monitoring because some men with prostate cancer never need treatment. Prostate cancer is generally a disease affecting older men. Some prostate cancers develop quite quickly (over a few years) but most develop very slowly. We know from post mortems that most older men who have died from other causes also have signs of prostate cancer. They had not had any symptoms from the cancer and did not know they had it.

It is difficult for doctors to tell whether a prostate cancer is going to grow quickly or slowly. Blood tests and scans can now detect prostate cancer earlier and earlier. So when doctors diagnose a prostate cancer from tests, they may want to wait to see whether the cancer is going to develop, rather than giving treatment straight away. In this way, they can avoid unnecessary side effects that could seriously affect your quality of life.

All cancer treatment has side effects. Apart from the immediate side effects when going through treatment, some men have long term problems after prostate cancer treatment, such as urine leakage (incontinence) or difficulty getting an erection (impotence). Obviously it is best to avoid these problems if at all possible.

The regular blood tests and checks during active monitoring mean that your doctors will pick up any growth of the cancer and then you can have appropriate treatment.

Some doctors use these terms as if they mean the same thing. But they are slightly different. In a nutshell, you are having active surveillance if your doctor intends you to have radical treatment to try and cure your prostate cancer if it starts to grow.

Watchful waiting means keeping treatment to control prostate cancer in reserve, because you aren't having any symptoms. Either your cancer is locally advanced and is likely to be too far grown to cure. Or you have other medical conditions that mean you are not fit enough for radical surgery or radiotherapy. Doctors keep treatment in reserve because you may never need it if your cancer does not cause you any problems. It can also help to control your prostate cancer for as long as possible. Prostate cancers can develop resistance to treatment so it is best not to start it before you have to.

You may have active surveillance if you are diagnosed with localised prostate cancer that may never need treatment. Your specialist will take into account

• Your PSA test results
• How the prostate cancer cells look under a microscope (the Gleason score)
• The size of your prostate gland
• Your views about treatment

You usually go to the hospital for regular appointments and have

• Blood tests every 1 or 3 months to monitor your prostate specific antigen (PSA) levels
• Regular digital rectal examinations
• Prostate biopsies every 2 to 3 years

At each appointment your doctors will also ask if you have developed any new symptoms. If you develop symptoms, or if your test results show that the cancer is starting to grow, you can either have surgery to remove the prostate gland or radiotherapy to the prostate to try to cure it.

UK Prostate Link can direct you to information about managing prostate cancer without active treatment.

You may have watchful waiting if you

• Have localised prostate cancer with no symptoms but have medical problems that mean you can't have radical treatment
• Have locally advanced prostate cancer with no symptoms
• Have prostate cancer that has come back after surgery or radiotherapy and is not causing symptoms

Watchful waiting means keeping treatment to control prostate cancer in reserve, because you aren't having any symptoms. Generally, watchful waiting involves fewer tests than active surveillance. You will still have regular appointments, blood tests and examinations. But you are less likely to have regular prostate biopsies. Your doctor may suggest that you have a bone scan.

You can discuss with your doctor how often you need tests. Specialists recommend PSA testing at least every year. You may be able to have your monitoring at your GP surgery instead of having to go back to the hospital for every appointment.

If you develop symptoms, your specialist is likely to suggest hormone treatment to shrink and control the cancer.

Some people find it very stressful to know they have a cancer and not have any treatment straight away. Firstly, do talk to your doctor about what they are suggesting. Once you know what is being suggested, do feel that you can talk to your doctor about how you feel about monitoring. You may feel reassured when your doctor explains how often you will have checks and what the treatment options may be if the cancer starts to grow.

During monitoring, there are some things you can do which may help to keep you healthy and will help you to feel you are doing something positive

• Eat a healthy diet
• Learn to relax if you can
• Stop smoking – smoking can make it more likely that prostate cancer will grow quickly or come back after treatment
• Take notice of any new symptoms and report them to your doctor

We know in general that a diet high in fresh fruit and vegetables and fish, and lower in animal fats is better for your health.

There is currently no hard evidence linking stress to cancer. But monitoring can be a stressful situation for some people and relaxation will help you feel better and probably cope better too. You could find a new hobby or try relaxation tapes. Libraries often have tapes they can lend to you.

Along with stopping smoking, making changes like these to your lifestyle will help you to feel more in control of your situation. You are taking positive steps to improve your health and that is a good thing.