How do I transition from active treatment to surveillance for Prostate Cancer

Transitioning from Active Treatment to Surveillance for Prostate Cancer

This is an important question that many prostate cancer patients face. Let me help you understand the framework for this transition and what questions to ask your care team.

Understanding the Clinical Thinking

According to the CancerPatientLab webinars on prostate cancer management, the transition from active treatment to surveillance depends on several key factors about your specific cancer:

The Core Decision Points:

As explained in the "Liquid Biopsies" webinar, doctors evaluate prostate cancer using markers that help determine how aggressive your cancer is and how it's responding to treatment. The key question becomes: Is your cancer truly controlled, or does it need continued active treatment?

For example, if you have a Gleason 6 cancer (a lower-grade form), the medical literature shows these cancers typically grow very slowly and may not require aggressive ongoing treatment. However, the challenge is that Gleason scores become less useful over time—better measures are PSA doubling time (how quickly your PSA is rising) and time to biochemical recurrence (how long after initial treatment before PSA starts rising again).

Key Markers That Guide the Transition

According to Dr. [removed] Armstrong's guidance on advanced prostate cancer treatment, doctors typically monitor:

1. PSA doubling time: If your PSA is rising very slowly (>15 months), this suggests slower-growing cancer
2. Scan findings: Whether imaging shows stable disease or progression
3. Symptoms: Whether you're experiencing cancer-related symptoms
4. Overall health: Your age, other medical conditions, and life expectancy

What "Active Surveillance" Actually Means

This is NOT "doing nothing." According to the webinars, active surveillance (sometimes called "watchful waiting") involves:

• Regular PSA blood tests (typically every 3-6 months)
• Periodic imaging scans (like PSMA PET scans) to check for progression
• Clinical exams with your oncologist
• Readiness to restart treatment if your cancer shows signs of progression

As one webinar participant noted, the concept is: "Wait till you see the enemy's eyes before you shoot"—meaning, wait for clear evidence of aggressive behavior before restarting treatment.

Important Considerations for Your Transition

Timing Matters: According to the "Treating My Osteoporosis and My Prostate Cancer" webinar, if your time to biochemical recurrence is greater than 3 years AND your PSA doubling time is greater than 15 months, you may be a good candidate for active surveillance rather than immediate treatment restart.

Quality of Life: The webinars emphasize that men on long-term hormone therapy (androgen deprivation therapy/ADT) experience significant side effects including:

• Bone loss and osteoporosis
• Cardiovascular complications
• Fatigue and sexual dysfunction
• Cognitive changes

If your cancer is growing slowly, avoiding or delaying these treatments can preserve your quality of life.

The "One Size Fits All" Problem: Dr. [removed] Subudhi notes in the immunotherapy webinar that prostate cancer treatment has historically been too standardized. Your transition plan should be personalized based on YOUR cancer biology, not just a general protocol.

Questions to Ask Your Oncologist

Before transitioning to surveillance, discuss these specific points:

1. "What is my PSA doubling time, and what does it tell us about my cancer's aggressiveness?"

2. "Based on my specific biomarkers and scan results, am I a good candidate for active surveillance right now?"

3. "What specific PSA level or imaging findings would trigger us to restart active treatment?" (This helps you understand the "trigger points")

4. "How often should I have PSA tests and imaging scans during surveillance?"

5. "Are there any genomic tests (like DNA sequencing or liquid biopsies) that would help us monitor my cancer more precisely during surveillance?"

6. "What are the risks and benefits of surveillance versus continuing treatment for MY specific situation?"

Monitoring During Surveillance

According to the webinars, modern surveillance can include:

• Traditional PSA monitoring (though PSA can be tricky in some situations)
• Liquid biopsies (blood tests that detect circulating tumor DNA or circulating tumor cells)
• Advanced imaging like PSMA PET scans (more sensitive than traditional scans)
• Fragmentomics (analyzing patterns in cell-free DNA from blood)

These newer tests may give earlier warning of progression than PSA alone.

The Bottom Line

The transition to surveillance is appropriate when your cancer shows signs of being slow-growing and well-controlled. However, this requires:

✓ Clear agreement with your oncologist on what "controlled" means for YOUR cancer
✓ Understanding your specific PSA doubling time and other prognostic markers
✓ A concrete plan for monitoring and trigger points for restarting treatment
✓ Regular follow-up to catch any changes early

This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.

---

Sources Referenced:

• CancerPatientLab Webinars: "Liquid Biopsies" (Peter Kuhn and Stephanie Shishido)
• CancerPatientLab Webinars: "Guiding Personalized Treatment for Advanced Prostate Cancer (Round Two)" (Andrew Armstrong)
• CancerPatientLab Webinars: "Treating My Osteoporosis and My Prostate Cancer" (Jeff Dwyer)
• CancerPatientLab Webinars: "Update on Immunotherapies for Metastatic Castrate Resistant Prostate Cancer" (Sumit Subudhi)