Prostate cancer is very common in older men. It has been said if we lived long enough, all men would get it. It is not uniform in its behavior. Prostate cancer is often given what is called a “Gleason” score for its aggressive features. This score, if high, is associated with more rapidly progressive disease.
Most prostate cancer is also staged using a scale that measures the tumor locally, and takes into account lymph node and metastatic involvement.
Of course, the sooner any cancer is diagnosed, the better—both for the stage and, consequently, the prognosis. Prostate cancer may be very idle in some males. In the group of men with early-stage cancer, low Gleason scores, low PSA (prostate-specific antigen) levels, cancer shows up in only a couple of biopsy specimens. Even then, it involves less than 50 percent of the specimens that seem to bear “watching.”
Of course, age is a very important factor as well. Men 65 or younger—as a group—are treated more aggressively to match the usual state of their cancer, which tends to be more aggressive.
“Watchful waiting” is more importantly “watchful.” Strict monitoring is required. A rapid rise in PSA, or a change in Gleason score on follow-up biopsies, or palpable growth would all indicate a need for intervention.
Some may ask, “Why wait?” Life expectancy may, for some, be much shorter than the prostate cancer’s course. All treatments carry significant risk of complications. These include impotence, urinary incontinence, and possibly rectal irritation following irradiation of any kind.
The patient’s comfort in waiting must also enter into the equation. Some feel much more content hitting the cancer hard while others would prefer a more cautious approach.
If your urologist is keeping a close eye on you, at your age, with a less aggressive tumor, it is quite possible that you could live many years and die of an unrelated condition.
A recent study out of Johns Hopkins reported on a group of 38 men who fit the criteria for watchful waiting. This group did just as well as a group of 150 men who underwent immediate surgery. Much study is ongoing in this area. New advances made every year mean that hope for cure improves each year as well.
For readers wondering what can be done to prevent prostate cancer, current understanding finds no correlation between sexual activity and prostate cancer. Dark-skinned males have increased prostate cancer, especially in more northern climates. This suggests vitamin D—the “sunshine” vitamin—may be important in protecting against prostate cancer.
Lycopene, found in tomatoes and released from them more by cooking, also may be protective, as may be a moderate intake of soy products. Selenium, found in Brazil nuts, may also be protective.
One of the factors we can do little about is our genetic predisposition, which prostate cancer involves. When there is a strong familial tendency, greater vigilance is called for.