Prostate Cancer May Not Need Immediate Treatment

BALTIMORE -- Doctors say men diagnosed with prostate cancer should be sure to consider all treatment options -- including no immediate treatment.

Bill Lewis, who was recently diagnosed with prostate cancer, found himself face-to-face with his own mortality, reported WBAL-TV in Baltimore.

"Cancer is such a scary term, and we always associate it with bad outcomes in almost all cases, and we often have relatives or dear ones who've died from it," Lewis said.

Lewis' doctor recommended surgery to completely remove his prostate, but Lewis wanted to fully explore his options.

"What were the consequences of treatment? How likely was the treatment to cure me? What were the likely side effects? And the more I heard about the side effects, the more concerned I got," Lewis said.

Like Lewis, many men face fear of the side effects that could include impotence, incontinence and bowel dysfunction.

Lewis eventually found Dr. Ballentine Carter, who is the co-director of the Johns Hopkins' Brady Urological Institute. He runs the Expectant Management Program.

"In about 20 to 30 percent of cases that we diagnose today with (prostate-specific antigen) screening, men have very small amounts of cancer within the prostate," Carter said.

Carter believes no treatment is sometimes the best treatment.

"The first thing a man needs to ask when he gets diagnosed with prostate cancer is: 'Does my cancer need to be treated?'" Carter said.

While doctors sometimes find it necessary to completely remove prostate cancer, for some men, that can cause more harm than good.

"They can be monitored very carefully as an alternative to immediately treating their prostate cancer," Carter said.

Carter looks at three factors combined before deciding whether a patient is right for expectant management. They include:

1. Age: The older the man, the less likely his cancer will endanger his life.
2. The PSA level as it relates to the size of the prostate.
3. The features of the prostate biopsy itself.

"If we think someone has small-volume cancer and we think they'd be an appropriate candidate, we re-biopsy them immediately," Carter said.

If the second biopsy confirms a small amount of cancer, the patient enters the Expectant Management Program and follows a monitoring plan.

The plan includes a PSA test and rectal exam every six months, in addition to a surveillance biopsy of the prostate once yearly. No other treatment is necessary unless the cancer becomes aggressive.

Three years after his diagnosis, Lewis has recovered well and believes it's all because of the Expectant Management Program.