We Are All On Active Surveillance

One of the treatment options following a diagnosis of low-volume or low-risk prostate cancer is Active Surveillance. Briefly this means deferring any intervention such as surgery, radiation, hormones or chemotherapy and keeping a watchful eye on key markers of prostate cancer progression until it demonstrates a change in nature and threat. Your urologist will order regular PSA tests, physical examinations and/or imaging of your prostate to provide comfort (no progression) or early warning that something now needs doing.

Active Surveillance (AS) has a much wider role than this. For example, because my Dad died from prostate cancer I regularly have PSA and physical checks on my prostate with no cancer evident as yet. So I am on AS pre-diagnosis.

Around 8000 men in Australia may well be on AS post-diagnosis.

Then there are men who have undergone treatment for prostate cancer (removal, zapped, drugged) and are still monitoring their PSA to detect any secondary cancers from rogue prostate cells that escaped the procedure. These men are on post-treatment AS.

Active Surveillance is simply a man taking a pro-active, risk management approach to his prostate health. Whether he be screening, deferring treatment or monitoring ongoing status following treatment we are all on our own journey.

One thing we all share, is the hope that we can avoid or suppress the progress of prostate cancer wherever we are on the scale. That is where the ‘Active’ part of AS comes into play. Every man can actively sabotage prostate cancer no matter his risk factors or diagnosis. The challenge for every man however, is – can he and will he make the sustained lifestyle choices that make his body hostile to prostate cancer instead of a receptive host? Could you?

To answer this question you need to understand the commitment involved. You need to be prepared to give up things that you enjoy (not all) and adopt other behaviours that may not seem so attractive. Yes, you have to make an effort and get out of your comfort zone. Not all men can do this. Not for a week or a month, but from now on. For as long as you want your prostate gland to behave.

Some examples, are you prepared to –

  • Reduce dairy consumption
  • Get more physical training
  • Eat less red meat
  • Keep drinking coffee
  • Increase water consumption
  • Reduce stressful aspects of your work, life, family
  • Maintain a waist girth of less than 95cm?

Even a couple of ‘yes’ responses on this list is a win. You don’t necessarily have to do them all, certainly not at once.

If you want more information and specific strategies to resuce the onset, progression and recurrence of prostate cancer you can find it in my book – The Prostate Playbook. This is available online by clicking here. For less than $20 (AUD) you can have your own playbook with heaps of ways you can defend against prostate cancer.

Written by a men’s health physiotherapist it is based on science, evidence and clinical sense.

All the best,

Craig Allingham
A/Prof. Bond University, School of Physiotherapy & Exercise Science
Men’s Health & Sports Physiotherapist

  • Prostate Recovery MAP
  • The Prostate Playbook

Coffee, Vitamin D & PCa

Two new pieces of research have confirmed the information contained in The Prostate Playbook. The danger of publishing health advice is that more recent research might not support the advice given. When it does support my book, however, I am really chuffed. Two research projects published in the International Journal of Epidemiology have confirmed that coffee consumption is not linked to prostate cancer (2019), and circulating levels of Vitamin D are likewise not linked to the incidence of prostate cancer (2018).

So my advice in the book remains current and once again supported by published research.

Women & Prostate Cancer

The effect of prostate cancer is usually indirect where a male partner, father, brother, son or friend is diagnosed with the disease. Depending on the closeness and nature of the link with the man, a woman may be caught up in the anxiety, fear, decision making confusion, treatment recovery and long-term side effects.

However some women can have a direct link to prostate cancer following gender re-assignment surgery. Men who transition to female undergo a complex surgical procedure to reconstruct their pelvic appearance and function. Generally the prostate gland is left in place as removing it adds further complexity and risk of complications. Hormone manipulation to increase feminization may reduce prostate gland size and activity but it still has the potential to develop a tumor.

If this occurs, the woman has the same challenges of deciding on what treatment (if any) and how to cope with any subsequent side-effects.

The Prostate Playbook is written for men, however if a women with a prostate gland can overlook the constant male pronoun and male references she will find valuable information to reduce her chances of developing a prostate cancer or of an existing low-risk cancer progressing to the point of needing treatment.

For those women who have outsourced prostate care to their male partner, The Prostate Playbook is a valuable tool to understand and support the life changes necessary to help prolong his life. Given that most health books are purchased by women, she may even be the catalyst for his action by presenting him with The Prostate Playbook at the one time in his life that he might actually accept some advice. Check out the blog post on how to introduce the book to a man in a way that he is most likely to read it.

Putting the ‘Active’ in Active Surveillance

Many men are receiving a diagnosis of prostate cancer that is rated as low-risk or low-volume in terms of it’s likely progression or threat. Almost 50% of the new diagnoses this year in Australia will fall into this category, that’s around 8,000 men who may be offered the choice of deferring treatment by their Urologist.

Surveillance is only half the story….

During the period of deferring treatment the Urologist will recommend regular testing of key prostate disease markers such as Prostate Specific Antigen (PSA), Gleason Score (aggression rating) or imaging of the prostate to detect changes in cancer volume. This is the surveillance component of a management program called Active Surveillance.

These men are initially very relieved to discover that their cancer does not demand immediate surgery, radiation or hormone treatment due to its advanced state or aggressive nature. They leave the Urology office and resume life, work and relationships without the prospect of facing the side-effects of treatment, namely incontinence and erectile dysfunction.

However they often become uneasy when they realise they are now living with an active cancer in their prostate and nobody is recommending treatment (except perhaps for his spouse or children). He may become anxious about the cancer and fret about his future and constantly worry that not treating may not be the best option, despite the evidence from the pathology reports and recommendations from his Urologist. He may feel dis-empowered.

He needs to invest in the Active part of the treatment plan. He needs to educate himself about his prostate gland, cancer and what he can do for himself to slow the progression of any cancer and undermine its development so he never needs treatment. But the Urologist didn’t provide any resources for ‘non-treatment’, just reams of information on incontinence and erectile dysfunction and depression associated with interventional procedures such as surgery, radiation or androgen deprivation therapy (ADT).

Yet there is a huge amount of research and experience demonstrating that men can reduce the progression and development of a low-grade prostate cancer through lifestyle decisions, reducing their stress, physical training and smarter eating habits. The Prostate Playbook is a strategic guide for men and their support team to take some control of their outcome and take action to sabotage their prostate cancer. For these men, the goal is to frustrate the surveillance through smart plays everyday to stay well.

The Prostate Playbook is to be published in May 2019. It will be available in Australia and New Zealand bookstores from June or you can purchase it online after May 15 at this website.