How can I be told I have cancer of the prostate, yet also be told it does not need to be treated?

Expert Opinion published on January 13, 2012 in Treatment
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Donald L. Trump, MD, FACP
President and Chief Executive Officer
Roswell Park Cancer Institute
Buffalo, New York
How can I be told I have cancer of the prostate, yet also be told it does not need to be treated?

A question that often comes up comes from the patient who has been recognized to have prostate cancer that is localized to the prostate, does not seem to have spread, and their physician may suggest that no treatment at all is an appropriate option, the so-called active surveillance or watchful waiting approach. This can be confusing, but this recommendation is based on the fact that we know prostate cancer is very common in men as we get older. In fact, it has been estimated that if you could examine the whole prostate in every man who is over the age of 80, that approximately 80% of those men would have detectable prostate cancer in their prostate. And clearly, 80% of men do not die of prostate cancer. So, prostate cancer occurs much more often than it is necessary to treat or is a cause for illness. We are increasingly able to pick out those cancers that are unlikely to cause future problems. The best criteria at the present time are the amount of cancer that is in the prostate biopsies as well as the appearance of the cancer under the microscope, the grade or malignancy or anger of the cancer, if you will, and that is the so-called Gleason Grade. And for low-grade, unaggressive appearing tumors that are small in volume on biopsy, it is very clear that many of those patients, particularly men in their 60s and 70s, do not need to have treatment at all, but can pursue the so-called active surveillance approach, regular PSA monitoring, regular physical examination and no treatment at all is often appropriate and is not associated with any impairment in longevity or quality of life.

Last modified: February 7, 2012
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