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Active Surveillance for Prostate Cancer: Who Is It Right For?

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Published on September 25, 2014

Dr. Daniel Lin, chief of urologic oncology at the University of Washington, shares what active surveillance is and how patients are monitored through PSA measurements, biopsies and digital examinations. As a leader in the world-wide Prostate Active Surveillance Study, Dr. Lin talks about the goals of the study which are focused on discovering new ways to understand what treatments may be right for each patient. Learn about other available options for newly diagnosed prostate cancer patients and why Dr. Lin and his colleagues at SCCA tailor treatments based on each patients individual diagnosis.

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Transcript | Active Surveillance for Prostate Cancer: Who Is It Right For?

Please remember the opinions expressed on Patient Power are not necessarily the views of Seattle Cancer Care Alliance, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

When a man is diagnosed with prostate cancer, there are decisions to be made.  For instance, do you go ahead right away with treatment, or maybe not.  Maybe you have something called active surveillance.  One of the leaders in the field of active surveillance, studying it for many years, is Dr. Daniel Lin.  He is chief of urologic oncology at the University of Washington.  He's also an associate member at the Fred Hutchinson Cancer Research Center, and he sees prostate cancer patients at the Seattle Cancer Care Alliance.  And he joins us now once again on Patient Power.  Dr. Lin, welcome back. 

Additionally, we look at the biopsy characteristics, in other words, how many of the pieces of prostate tissue that are taken out have prostate cancer, and we usually reserve active surveillance for those men that have one, two or three biopsies, let's say, out of 12 that have prostate cancer and in each of those pieces of tissue a low volume within those pieces.  So it's the classic turtle on the block, if you will, cancer, that is, what we feel like is a slow?growing cancer.  Those are what we call low?risk cancers.  Those would be the candidates for active surveillance.  

And the goal of the PASS Study, and it is now the largest study in the world, the prospective study, to understand men that have chosen active surveillance, and the goal is to find biomarkers.  So biomarkers are those markers that might be in the tissue, the urine or the blood of our patients that can give us an indication of the cancer beyond what we already listed, which was the PSA and the Gleason score. 

And so the goal of this study was to study, now we have over 1,200 men over time, and we gather their specimens. And we follow them not only to understand how they do on active surveillance but also to try to discover new ways of telling a man whether he should get treatment instead of active surveillance or conversely whether the cancer appears by these new novel biomarkers to be more indolent and that it would be safe for him to forego treatment and the side effects and to go on with active surveillance. 

We've been going on, again, as I said, for about eight years, coming up on eight years now, and we have built this machine, and now we're getting more funding from the government and other agencies. And I hope that in a few years you and I will talk again about some novel discoveries within active surveillance that we don't have at this point in time. 

And so I put there to my patients that we individualize our treatments.  There are some patients that despite looking like a low?risk prostate cancer would probably not be the best patient for active surveillance based on other factors, perhaps such as they don't want to have serial biopsies.  They're very anxious about their prostate cancer.  Perhaps it's in multiple areas of the prostate that we feel like might not be the best candidate. 

Similarly, there are patients that come in and say, I want surgery. But when we look at them and we understand their history, perhaps multiple surgeries, perhaps very sick patient that would not withstand surgery, we might steer them in a different way.  So here at the SCCA, we certainly personalize our treatment based on the patient, but there are multiple options, as you said, for newly diagnosed prostate cancer. 

Please remember the opinions expressed on Patient Power are not necessarily the views of Seattle Cancer Care Alliance, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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