Not every patient wants or needs surgery or radiation. For many men, including those with "low risk" or early stage prostate cancer, those advanced in age or those with other serious health problems, observation is preferred to more radical treatments.
Many men live for more than 20 years with "low risk" prostate cancer. Observation is an appropriate strategy for many of these men, and may be considered in two formats:
- Watchful waiting – A more passive approach that consists of symptomatic monitoring. This is generally used for men of more advanced age or with significant other health issues.
- Active surveillance – A more aggressive monitoring approach consisting of more frequent PSA and digital rectal exams, and repeat biopsies at various intervals tailored to the individual. This approach monitors patients to ensure no progression of disease, and to ensure that additional cancer was not missed on the initial biopsy. Prostate MRI is used routinely in active surveillance patients to ensure there is not additional significant prostate cancer that has evaded detection, and to enable targeted biopsy of suspicious areas if needed. Prostate MRI is often called "multi-parametric MRI," and DHMC offers specialty radiology services including this exam.
Both approaches are intended to monitor the state of a prostate cancer, and additional tests or treatments may be needed if over time there is a significant change in disease, symptoms, or a patient's preferences.