Prostate Cancer – Active Surveillance – Or Active Participation?

New results from a randomized trial comparing active surveillance of men with low or medium-risk prostate cancer with active treatment – surgery or radiotherapy followed by hormone therapy – is causing nervousness for advocates of active surveillance. A clinical trial comparing active surveillance with active treatment found that more men in the active surveillance group developed metastases compared to those in the active treatment group, although deaths from prostate cancer and other causes were the same for the two groups after 10 years. Deaths from prostate cancer were somewhat lower in men who had surgery, though not significantly, and men in the active surveillance group were more likely to have disease progression.
Active surveillance, also called “watchful waiting,” was proposed for prostate cancer because there are, in fact, many men whose early-stage disease does not progress. Subjecting all of them to surgery or radiotherapy as well as hormone therapy means that many men suffer the substantial side effects from these treatment who would never have experienced disease progression. In active surveillance, early stage prostate cancer patients initially forego treatment. Instead, they go through regular testing to detect any worsening of their early-stage disease, and undergo treatment only if signs of progression are found.
I’ve never been enthusiastic about active surveillance – which in many respects seems like passively watching — and neither are most of our patients. No one chooses to undergo unnecessary treatment, but just waiting for your cancer to get worse — or not — doesn’t strike me as an satisfactory strategy. What I recommend for patients with very low-risk disease is what I call “active participation.” Active participation means revising your lifestyle to be cancer-suppressive rather than cancer-fueling.
There are many science-supported, health enhancing lifestyle alterations and dietary supplements that help with active participation. One randomized trial of a low-fat, plant-based and omega-3 supplemented diet, exercise and support groups for 93 men with early prostate cancer and PSA levels less than 10 found that 25% of the control group but only 5% of lifestyle patients had to have surgery, radiation or hormone therapy. None of the lifestyle patients but 3 control patients had PSAs over 10 by the end of the trial. A study of gene expression found that the gene for an enzyme called matrix metalloproteinase, which helps metastatic cancer cells drill their way into new tissues, was suppressed in the lifestyle group.
There are also other trials that were not carried out specifically in active surveillance patients, but that I believe give us insight on ways to slow prostate cancer progression in early-stage disease. A study of a supplement containing pomegranate, broccoli, turmeric and green tea demonstrated that prostate cancer patients whose PSA was increasing actually slowed down that rate and reduced the number of patients who needed active treatment. Prostate cancer patients in stages 2-4 who engaged in approximately 3 hours a week of casual bicycling or 4 hours of brisk walking had a 40% reduction in mortality. Other helpful interventions are maintaining a healthy body weight, eating a diet rich in fruits and vegetables, especially cruciferous vegetables and tomatoes, along with consuming healthy vegetable fats and reducing saturated fats. Even drinking coffee (as long as you don’t fill it with cream, sugar and calories) is associated with a reduced prostate cancer risk! All these lifestyle changes, of course, also lower your risks for cardiovascular disease, a major killer among men with prostate cancer.
If you have early stage prostate cancer, you need to have a serious discussion with your doctor about going ahead with treatments that can mean substantial side effects versus undertaking the risks that are apparently associated with active surveillance. If you choose to delay treatment, though, active participation in improving your health is the best way to maintain your quality of life while restraining your prostate cancer from worsening. Call the Block Center for the guidance you need to actively participate in bettering your own health and reducing the risk of disease profression!