As Fans for the Cure pivots to more online offerings to support men during the coronavirus pandemic, we launched a new FAQ section on our website. Over time, this FAQ will provide answers, informations, links, and sign posts to more in-depth guidance in response to topics raised in our online support groups and at health events in communities we serve.
Prostate Cancer FAQ
Are “active surveillance” and “watchful waiting” the same?
We often hear the terms “active surveillance” and “watchful waiting” used interchangeably as recommended initial treatment strategies for low-risk and localized cases of prostate cancer. But are they the same thing?
The short answer is no.
As she shared on the Stay in the Game podcast, Dr. Stacy Loeb emphasized that active surveillance is active. While radiation therapies or prostatectomy surgery are not undertaken upon diagnosis in these patients, more frequent testing and monitoring are – including PSA tests, reflex texts (e.g. 4Kscore), MRIs, digital rectal exams, and biopsies. The goal is to appropriately address – and not overtreat – low-risk cases, while closely monitoring any changes to the velocity of the disease.
Watchful waiting refers to an approach taken with men who, for several reasons and in consultation with their physicians, might not wish to deal with the side effects and discomfort associated with radiation, surgery, or frequent testing.
Age: A man and his doctor might conclude that due to age and the specifics of his case, the odds overwhelmingly favor that man dying with prostate cancer and not because of it.
Age and Quality of Life: Men and their doctors conclude that the statistical life-expectancy gains of treatment simply do not justify the risk of treatment plan’s side effects or the ongoing pain and inconvenience of frequent testing.
In short, watchful waiting is active surveillance minus the frequent testing and possible pivot to radiation or surgery. Based on age and disease velocity, there are often transitions from active surveillance to the fewer doctor visits and less aggressive testing of watchful waiting.
Doctors and healthcare institutions have spent the past five months telling us to avoid non-emergency in-person appointments. I have missed my annual physical. Should I simply wait until next year when it should be safer to go to doctors’ office and hospitals?
Depending on where you live and receive your healthcare, you might want to call your doctor’s office to get advice about how to handle your appointments. Many physicians’ offices and hospitals in the United States have returned to in-person appointments, with careful provisions for social distancing, limiting waiting times, and pre-screening patients with telephone health checks and temperature checks as one enters the buildings.
As for prostate cancer, reports we have received through July show PSA screenings to be significantly down for January through July 2020. The good news is that anecdotal information indicates that appointments and testing have picked up in August. Again, a reminder – in years where testing numbers have decreased, a far higher percentage of the diagnoses have been later-stage, more serious cases of prostate cancer rather than cases detected in the earliest stages.
Does an elevated PSA score mean that I have prostate cancer?
Prostate-specific antigen is a protein produced by both cancerous and non-cancerous tissue in the prostate. While small amounts of PSA are regularly present in the blood, the PSA test excels in detecting high levels of this protein in the blood which might indicate cancer. But high PSA levels might also indicate an enlarged (BPH) or inflamed prostate (prostatitis), or recent sexual activity.
The PSA test is not perfect, however. One of its limitations is that it has produced misleading results – both false positives and false negatives. Men with elevated PSA levels have been found to be cancer-free with further testing, and men with PSA values within the “acceptable” range have been diagnosed with prostate cancer.
We recommend having open and honest conversations with your doctor about the risks and limitations of the PSA testing, as well as a preliminary plan of action based on both positive and negative results.
When should a man be tested for prostate cancer?
Beginning at age 40, men should begin a conversation with their doctors about the benefits and limitations of prostate cancer screening tests, particularly the PSA (prostate-specific antigen in one’s blood).
Should you choose prostate cancer screenings, you should get a PSA test somewhere between the ages of 45-50. If you are African American or have a family history (father, uncles, brother, son), you should strongly consider getting tested (PSA, optional digital rectal exam) at or before age 45.
We recommend regular screenings between the ages of 50-75 at intervals decided upon by men and their doctors, based on test results and monitoring year-to-year increases in ng/mL values.
Between the ages of 76-85, men should continue their dialogues with their GPs and urologists to decide on a testing regimen for those years. Most healthcare websites discourage PSA testing for men over the age of 85.
What are the most common signs of prostate cancer?
The main reason that screening for prostate cancer is so important is that the vast majority of the localized – and most curable – cases of prostate cancer have no symptoms. A decrease in the force of the urinary stream, difficulty starting urination, and frequent nighttime urination are more likely to be BPH, or benign prostatic hyperplasia.
Note: A diagnosis of BPH does not completely rule out prostate cancer. There have been cases where BPH occurred coincidentally with the prostate cancer.
About 10% of all diagnoses, however, indicate advanced-stage prostate cancer that has spread outside the prostate and the lymph system. These cases are likely to have symptoms similar to those of BPH, including blood in the urine, painful urination and a decreased urinary flow.
Additional information is available on the Signs and Symptoms of Prostate Cancer page.
Ask Your Question
If you have a question about prostate cancer that you would like us to answer, we invite to you submit it to us via the form on our Ask Us a Question page.