Page 2 - Active Surveillance for Prostate Cancer
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Active surveillance for prostate cancer

        Active surveillance
                                                                  men will notice some increased urge to void as well as
        During active surveillance, the cancer is carefully       an increased need to void during the day or night. These
        monitored for signs of progression. This usually includes   changes are often short-lived but some patients will
        a PSA blood test and rectal examination several times     notice permanent changes to their bladder function and
        a year to determine any significant changes. It is felt by   may develop urinary leakage. In the longer term, many
        many doctors that the rate of change of the PSA test      men having radiation therapy may also lose the ability to
        is a good indication that the prostate cancer may be      have natural erections.
        becoming more aggressive. Other tests (such as CT scans
        and MRI) may also be advised in special circumstances
        but are usually not a routine investigation in an active   Who should consider active
        surveillance program. However, your doctor may suggest    surveillance?
        a repeat prostate biopsy between one and two years
        after your diagnosis to try and confirm that your cancer is   The option of active surveillance can sometimes be a
        low risk.                                                 difficult one to understand and accept. Every man’s
                                                                  circumstances are unique, and there is no magic
        If symptoms develop, or if any of tests indicate that the   formula to help decide whether active surveillance
        cancer is growing, treatment such as surgery or radiation   is right for you. In general, active surveillance can be
        might be then warranted. The benefit of an active         considered a reasonable option for older men with
        surveillance approach is being able to avoid the risks and   other health issues and are diagnosed with early and
        complications of treatment, at least for many years, and   lower risk prostate cancer. Many of the treatment
        only undergoing treatment if it is felt that your cancer is   options for prostate cancer can be difficult to endure,
        becoming more aggressive.                                 and the healthier you are going into treatment, the
                                                                  more likely you are to have better outcomes. Especially
        Although it appears to be safe to delay treatment with    if you have other health issues, such as heart disease,
        surgery or radiation in many men with lower risk prostate   long-standing high blood pressure, or poorly controlled
        cancer, it can be difficult to accurately predict if, and   diabetes, active surveillance may allow you to avoid the
        when, your cancer will become more aggressive.            risks and complications of treatment if the cancer does
                                                                  not progress. To put things bluntly, these men are likely
        Side effects of surgery and radiation                     to have fewer symptoms related to their disease and
                                                                  are more likely to die with prostate cancer than die of
        The other available treatment options for prostate        prostate cancer.
        cancer, including surgery and radiotherapy, can have
        serious, long-lasting effects on your quality of life. In the   Some younger men diagnosed with lower risk prostate
        longer term, many men having a radical prostatectomy      cancer may choose active surveillance in order to delay
        may lose the ability to have natural erections. Also,     or possibly avoid the potential side effects of therapy
        some degree of urinary leakage after prostate surgery is   such as incontinence and erectile dysfunction. It is
        common requiring protection in the form of pads and,      important to realize this is a program of close observation
        rarely, additional surgery to restore control.            with an option to choose active treatment at any point
                                                                  if it is felt the cancer is progressing. The potential for the
        Similarly, radiation to the prostate can have early and   cancer to grow and spread during active surveillance
        more delayed side effects. Radiation to the rectum often   could be a concern. Some men find it stressful to know
        causes increased number of bowel movements and            they have cancer and may find it difficult to delay active
        some blood in the stool, although this often clears up    treatment.
        soon after treatment. Radiation can occasionally cause
        a variety of long-term problems with the bowels including   Discussing the pros and cons of the different treatment
        inflammation of the rectum (proctitis), with bleeding and   options with your physician and family can help you
        bowel problems such as diarrhea. It is common to notice   confidently choose the right treatment for you.
        changes in your voiding pattern during radiation. Most

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        The information in the publication is not intended to convey medical advice or to substitute for direct consultation with a qualified medical
        practitioner. The Canadian Urological Association disclaims all liability and legal responsibility howsoever caused, including negligence, for the
        information contained in or referenced by this brochure.                                     53E-ASPE-01-10
        © 2014. Canadian Urological Association. All rights reserved.
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