Is Active Surveillance Sustainable As Focal Therapy Improves?

Is Active Surveillance SustainableA recently published survey of European men examined how different prostate cancer treatments affected quality of life. The men surveyed had undergone radical prostatectomy, radiotherapy and active surveillance. Focal Therapy was not included, and had it been we would have a much fuller picture of treatments and their impact on quality of life. But by its absence, focal therapy stands out in this survey.

Active Surveillance performs best on many quality of life measures, including erectile function, continence, and fatigue. However, in addition to focal therapy, the survey omitted two things:

  1. Compliance: did the process of complying with the treatment impact quality of life?
  2. Mental health: how did the treatment impact patient mental health?

On these quality of life aspects, Active Surveillance often scores quite poorly.

As Alan Doherty, Clinical Director at the Birmingham Prostate Centre, suggests in our recent On Focus interview, patients undergoing Active Surveillance must comply with a sustained level of diagnostic activity, and many aren’t prepared to continue this indefinitely. Which leads to the very relevant question, as Alan puts it, what’s the endgame?. “The cancer isn’t going to go away under AS”, says Alan, “and this can cause needless anxiety in some men. If a curative treatment exists that is safe and effective, as is focal therapy, why wouldn’t you use it?”

TFTC patient Perry Letcher also has strong views on AS. In his case, described with great honesty in a recent On Focus interview and in his own words here AS didn’t accord with his personal mental and physical needs. A committed triathlete, Perry admits that he “needs to be in control” of all aspects of his life and is prone to anxiety. “I needed to feel in control, not that the prostate cancer was in control of me.”

TFTC Consultant Urologist Raj Nigam sees this all the time. As he states in his recent On Focus interview, “Too often AS is prescribed without an understanding of the whole patient context, or of the ‘whole man’”, says Raj. “Mental health is as important as physical health and must be investigated before proceeding with any treatment.”

The main issue today – as compared with five years ago – is that a treatment for prostate cancer exists that is continually improving in its efficacy and availability, and incurs minimal, if any, impact on quality of life. This is focal therapy, and The Focal Therapy Clinic is proud to be a world leader in its continued development.

5 Responses

  1. Not sure I agree with the above. The main issue is an inability of some urologists to council patients with low risk disease appropriately about AS, what it means, how it is done and the underlying evidence/rational for it. This coupled to their “interest” in focal therapy leads to many patients opting for an alternative therapy such as this. Proper prostate cancer needs proper treatment, low risk disease needs AS.

    1. Your opinion is shared by many conventional urologists who are concerned that Focal Therapy is not a sufficient treatment to eliminate intermediate prostate cancer diagnosis. The Clinical trials however contradict this point of view very effectively.

  2. We, on Active Surveillance, are in a very hard (superlatives do change) position. The blue touch paper of fear has been lit and we live from test to test for the PSA number. It is a matter of faith in the team who are overseeing your treatment and in your own religious faith. Prostate cancer does not go away, as remarked, so there is a medical and psychological consideration. A 6 month gap between tests can be a long time psychologically waiting for the next PSA number but, understandably, the medical reasons for this reduce the amount of consultations and tests. Limbo.

    1. Many men are finding that, during COVID 19 that their Active Surveillance has become Inactive and that they are being asked to accept long delays for PSA tests and MRI adding further to the anxiety of being on Active Surveillance in the first place when a valid and effective low impact treatment option is available.

  3. I am a man of age 72 and have been on sulvaillance for prostate cancer for nearly 6 years. My cancer is contained in my prostate and I have no symptoms. Most of the time my mental health is very good. My PSA is 13 and over 6 years average about 11. I get nervous before I get results of PSA blood tests and MRI scans. Because of results. But my last MRI scan showed a small increase in size, but this scan was after 3 years from the last scan. The cancer is still contained inside the prostate. I am very healthy and have no symptoms and take no medication for any conditions. My worry is all treatment have side affect. I don’t want to risk my very good health. Life is a gamble including COVID 19 now. Being 72 years of age. Is it worth taking a risk. All options of treatment are open?

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