Low-risk men like myself on active surveillance for prostate cancer would seem to be on Easy Street compared to men with advanced prostate cancer. We haven’t had our prostates removed in radical surgery nor have our glands been blasted with radiation nor frozen with cryotherapy. We don’t have to wear diapers for urinary incontinence from surgery or fecal incontinence from radiation. We don’t have erectile disorders from nerves damaged in prostatectomies. We aren’t in a complete mental fog from chemotherapy.
We do have it easy in some ways. Sometimes, I like to borrow a line from the Seinfeld program, describing active surveillance as being a treatment “about nothing.” But in reality, there’s more to it than that. Active surveillance is different. Sometimes, I call it “anxious surveillance.” I have been chill about it for the past decade, but I do meet some men who are worried about learning to live with cancer. Some men can’t live with the uncertainty and opt for radical treatments.
This ingrained fear isn’t surprising: for most of our lives, we have heard that when cancer is detected, we should have it out. Like right now; like yesterday. Out, out damned cancer spot, to paraphrase Shakespeare’s “Lady Macbeth.” That’s a message from the American Cancer Society and our doctors drilled into us. But active surveillance is different. Your cancer remains in place, perhaps for the rest of your life, “until you shuffle off this mortal coil” from some other cause to paraphrase Hamlet. (High school English finally is paying off after a half-century.)
Active surveillance involves learning to co-exist with your cancer. As a moderator for the past year for the Active Surveillance Group sponsored by AnCan and UsToo, I have heard about many of the worries men on active surveillance have about everything to do with living with cancer. I ran a SurveyMonkey survey of men on active surveillance and found that worries about multi-parametric magnetic resonance scans (mpMRIs) are at the top of the list of things men worry about. There are good reasons for that.
Among their questions and concerns:
- Can mpMRI alone be relied on to monitor their cancer so they need fewer biopsies? They also worry that biopsies put them at risk for sepsis and even erectile disorder.
- Is it true that some radiologists are better at reading MRIs than others? How can I find a skilled radiologist to read my scans?
- Is gadolinium, the contrast agent typically used with mpMRIs, safe? Does it cross the blood-brain barrier? What about the lawsuits?
- Are there safe and reliable alternatives to mpMRIs? What about the new micro-ultrasound technique? Any other techniques on the horizon?
There are more. You can expect to find some answers at a webinar featuring Antonio Westphalen, MD, head of abdominal imaging at the University of Washington in Seattle, at 8 p.m. ET on November 30. ZERO–The End to Prostate Cancer, AnCan, UsToo International, and several other prostate groups are sponsoring the free webinar. Make sure to register here.