Prostate cancer patients can choose watchful waiting or active surveillance if they wish to forgo immediate treatment

Prostate Cancer: Watchful Waiting vs. Active Surveillance

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About one out of every nine men will be diagnosed with prostate cancer during his lifetime, making it the second most common cancer in American men, behind only skin cancer.1 However, due to advances in cancer screening awareness and early detection, most men will not die from prostate cancer. In fact, many men who are diagnosed with an early-stage, low-grade cancer may need little to no immediate medical treatment. Instead, they can choose from two different methods of monitoring their prostate cancer: watchful waiting or active surveillance.

For men with prostate cancer, the goal of cancer management methods like watchful waiting and active surveillance is to avoid the side effects caused by cancer treatments like surgery or radiation therapy.

Both watchful waiting and active surveillance are ways of monitoring the cancer for changes, but the reasons for choosing one method over the other are different:

  • Watchful waiting is better for men who can’t undergo curative treatment. It is meant to manage symptoms by controlling the cancer, but is not intended to cure it.
  • Active surveillance is better for men who would benefit from curative treatment should the cancer become more aggressive.

Prostate cancer patients may wish to forgo immediate treatment, and instead use watchful waiting or active surveillance when:

  • There are no symptoms present
  • Gleason score indicates a slow-growing cancer
  • PSA level is relatively low (less than 10ng/mL)
  • Tumor size is small
  • Cancer has not spread beyond the prostate

In this article, we’ll explain the differences between watchful waiting and active surveillance, and which patients might be better suited for each. We’ll also look at the advantages and disadvantages of both methods and discuss your next steps if you’d like to discuss your diagnosis with a physician.

ABOUT WATCHFUL WAITING

Watchful waiting is used when there are no symptoms present. It involves closely monitoring a patient’s condition, but not treating the prostate cancer unless symptoms appear or change. During watchful waiting, men may undergo occasional prostate-specific antigen (PSA) tests or digital rectal exams (DRE), but this method mainly relies on watching for symptoms of prostate cancer.

You may also hear watchful waiting referred to as observation, watch and wait, or wait and see.

Men with other chronic, potentially life-threatening illnesses are best suited for watchful waiting because the risk of possible side effects from other treatments, like surgery or radiation therapy, could outweigh the benefits. Older men may also benefit from watchful waiting because other treatments may not help them live any longer, and the cancer isn’t likely to impact their quality of life.

If symptoms appear or change during watchful waiting, a patient may choose to discuss other treatment options, such as hormone therapy. Symptoms to look for during watchful waiting include frequent urination (especially at night), difficulty stopping/starting urination, blood in the urine, painful or burning sensation during urination, dull pain in the lower pelvis, and widespread pain in the lower back, hips or thighs.

Typically, treatment during watchful waiting is not meant to cure the cancer, but rather control it to help manage the patient’s symptoms.

Advantages of Watchful Waiting

  • Passive approach with fewer tests
  • Avoids side effects of surgery or radiation therapy
  • Cancer may never need to be treated

Disadvantages of Watchful Waiting

  • Cancer could grow or spread between follow-ups, making treatment harder
  • Patient must live with anxiety of having cancer, worry about it growing
  • Family members may worry and not understand why you aren’t treating the cancer

ABOUT ACTIVE SURVEILLANCE

Active surveillance is a more aggressive form of monitoring prostate cancer than watchful waiting. It involves a regular testing schedule, including a PSA test every six months and a DRE at least once a year. Imaging tests and prostate biopsies are also usually performed every one to three years.

You may also hear active surveillance referred to as active monitoring or deferred therapy.

The goal of active surveillance is to avoid or delay the need for other treatments like surgery or radiation therapy. This helps the patient avoid possible side effects like erectile dysfunction and incontinence for as long as possible.

If test results show that the prostate cancer is getting worse, a patient may choose to stop active surveillance and start a treatment plan designed to cure the cancer. Since treatment may ultimately be necessary, patients who are best suited for active surveillance include:

  • Men with slow-growing cancer that has not spread beyond prostate
  • Men whose benefit from surgery or radiation outweighs the risk

Advantages of Active Surveillance

  • Avoid sexual, urinary or bowel side effects for as long as possible
  • Regular testing means cancer is more closely monitored
  • Cancer may never need treatment

Disadvantages of Active Surveillance

  • Aggressive approach, more rigorous testing schedule
  • Regular biopsies are necessary
  • Patient must live with anxiety of having cancer, worry about it growing

NEXT STEPS FOR PROSTATE CANCER PATIENTS INTERESTED IN WATCHFUL WAITING OR ACTIVE SURVEILLANCE

If you have been diagnosed with prostate cancer, it’s important to understand all of your treatment options, and the possible side effects of each. This includes the options of watchful waiting or active surveillance. Your physician will consider many factors when helping you choose a treatment plan including: PSA level, tumor size, Gleason score (grade), cancer stage, age, overall health, family history, race, ethnicity and personal preference.

The board-certified radiation oncologists at Provision CARES Proton Therapy are experts in prostate cancer treatment. When you schedule a consultation with one of our physicians, they will be able to discuss the specifics of your prostate cancer diagnosis, and help determine whether watchful waiting or active surveillance may be beneficial for you.

They can also discuss your next steps and treatment options, including proton therapy, which is an advanced form of radiation therapy that reduces treatment-related complications and side effects compared to traditional x-ray radiation.

As a first step in moving forward with your cancer care, we recommend calling the Provision location nearest you. Our Cancer Care Experts can speak with you about your diagnosis, answer any questions you may have and, if desired, schedule you for an in-person or telehealth consultation with one of our physicians.

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As part of the Provision CARES Cancer Network, Provision CARES Proton Therapy has locations in Knoxville and Nashville, Tenn. If you or someone you know has cancer, we encourage you to call a Provision treatment center near you. One of our Cancer Care Experts can speak to you about your specific diagnosis and help determine if proton therapy is right for you.

1. National Cancer Institute. Surveillance, Epidemiology, and End Results Program. https://seer.cancer.gov/statfacts/html/prost.html

Delaying cancer screening tests during COVID puts patients at risk

Delayed Cancer Screenings in COVID-19 Era Put Patients at Risk

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When the COVID-19 pandemic began, life as we knew it came to an abrupt halt. That included routine healthcare visits, as many providers postponed appointments and cancer screening tests that were deemed “non-essential.”

In the United States alone, an estimated 22 million cancer screening tests were disrupted by COVID-19 from April to June 2020. As a result, about 80,000 patients could be at risk for delayed or missed diagnoses.

The IQVIA Institute for Human Data Science recently published these estimates as part of its report on shifts in healthcare demand, delivery and care during the COVID-19 era. In this article, we’ll look at how diagnostic procedures for some of the most common cancers are impacted. We’ll also share some tips to help you move forward with your cancer-related care in a timely and safe manner.

DRAMATIC DROP IN DIAGNOSTIC TESTS

The IQVIA report looked at insurance claims for five of the most common cancer screening tests – breast, cervical, colorectal, lung, and prostate – and found a significant reduction across the board as a result of COVID-19.

“Claim codes for diagnostics commonly used to screen and monitor for cancer were generally stable from March 2019 through February 2020,” noted the report’s authors. “However, as the country prepared for COVID by canceling/postponing non-essential visits, procedure codes throughout March declined dramatically, coming to a near stand-still for some tests by the first week in April.”

The number of cancer screenings during COVID dropped by up to 90%

As you can see in the chart above, colorectal cancer screenings took the biggest hit. In the week ending April 10, 2020, claims filed for colonoscopies dropped by 90%. Mammograms for breast cancer screening saw a similar decline (87%), as did pap smears for cervical cancer screening (83%).

The number of CT scans related to lung cancer and PSA tests for prostate cancer was also lower, but the reductions weren’t quite as dramatic.

While PSA tests did drop by 60%, some physicians may have opted to continue with scheduled screenings in order to adhere to the patient’s testing plan. This is because the severity of a potential prostate tumor is often measured by how much time it takes for the PSA level to double.

The report’s authors also reasoned that the lower rate of disruption for CT scans (a 39% reduction) could be due to the generally more serious nature of lung cancer. Physicians may have also been trying to rule out COVID-related issues in the lungs for some patients.

RISK OF MISSED CANCER SCREENINGS DURING COVID ERA

Using the screening data from early April, the IQVIA report went on to project how many patients could miss a diagnostic procedure between April and June 2020, and the risk that would create for potentially delayed or missed diagnoses.

More than 80,000 patients may have delayed or missed diagnoses because of delayed cancer screenings during COVID

In the chart above, you can see the estimated reduction in the number of tests ranges from 30 to 72 percent, depending on the cancer type. As a result, COVID-19 potentially disrupted more than 22 million cancer screening tests overall. That included an astonishing 13.2 million fewer pap smears and 7.2 million fewer mammograms over the three-month period.

It’s important to note that not all abnormal test results lead to a cancer diagnosis. With the rate of positive cancer diagnosis per test in mind, the report’s authors determined the reduction in screenings could put more than 80,000 patients at risk for a delayed or missed diagnosis. Breast cancer is estimated to be the most impacted (36,000 patients), followed by prostate cancer (22,600) and colorectal cancer (18,800).

A delayed diagnosis could ultimately lead to a more advanced cancer when it is diagnosed. Not only will that have negative impacts on a patient’s prognosis, but it could also have long-term effects on our healthcare system.

“Current excess healthcare capacity to catch-up on missed tests and associated cancer treatments would require providers to shift priorities to make time and space in schedules and facilities,” said the IQVIA report authors. “An immediate return to previous volumes of testing and care will require substantial reallocation of resources and likely last months after social distancing rules are relaxed.”

WHAT YOU CAN DO TO MOVE FORWARD WITH YOUR CARE

Provision CARES Proton Therapy is a strong advocate for timely cancer screening and treatment. As such, we have developed a list of guidelines to help you move forward with your care and avoid putting yourself at higher risk.

First and foremost, we encourage you to call your primary care physician and discuss any regularly scheduled procedures like a mammogram, pap smear, colonoscopy or PSA test. Based on your medical history, your provider can help you determine whether it’s appropriate to continue with your cancer screening during the COVID-19 pandemic or delay it.

If you do receive a cancer diagnosis, we can help you move forward with your cancer care in a timely and safe manner. Depending on your diagnosis, it may be appropriate to delay treatment until the COVID risk is lowered. However, some patients may be better off beginning their cancer treatment immediately. As a first step after your diagnosis, we recommend calling the Provision treatment location nearest you to speak with one of our Cancer Care Experts. They can discuss your specific diagnosis and, if necessary, schedule you for a consultation with one of our physicians.

During your consultation, you’ll be able to meet with one of our board-certified Radiation Oncologists. They will be able to answer any questions you may have about your diagnosis and review all of your treatment options, as well as the possible side effects of each.

Provision offers both telehealth and in-person consultations. Telehealth consultations allow you to speak directly with a physician from the comfort and safety of your own home.

Some patients may benefit more from an in-person consultation. We encourage you to follow the CDC’s guidelines for leaving your house for doctor visits during the COVID-19 pandemic. When you arrive at our facility, rest assured we have established our own standards of excellence to keep our patients, visitors and employees safe. All Provision cancer centers are stand-alone medical facilities, which helps limit your exposure to others compared to a busier hospital setting.

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As part of the Provision CARES Cancer Network, Provision CARES Proton Therapy has locations in Knoxville and Nashville, Tenn. If you or someone you know has cancer, we encourage you to call a Provision treatment center near you. One of our Cancer Care Experts can speak to you about your specific diagnosis and help determine if proton therapy is right for you.

 

CDC guidelines for visiting doctor during coronavirus pandemic

CDC announces guidelines for safely visiting your doctor during coronavirus pandemic

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The Centers for Disease Control and Prevention (CDC) recently announced new guidelines to help you stay safe when visiting your doctor or getting a prescription filled. In this article, we’ll outline some of the most important takeaways to help you stay safe during healthcare-related trips. More specifically, we’ll also share how those tips can be applied for people who are dealing with cancer.

As local governments loosen coronavirus restrictions and more businesses re-open their doors, it’s important for people to continue practicing preventive actions in order to slow the spread of COVID-19. These new guidelines from the CDC are designed to help you make an informed decision on when it’s appropriate to venture out of your home, and how to protect yourself and others when you do decide to go out.

THREE KEY TAKEAWAYS FOR HEALTHCARE-RELATED TRIPS

1. Consider telehealth/touchless options

The first key takeaway from the CDC guidelines on visiting your doctor is to find out whether your healthcare provider offers any telehealth options. Many doctor’s offices have telehealth programs that allow you to do a virtual video chat with a physician. It may also be possible to speak with your healthcare provider through secure communication lines using telephone or email.

If you need to pick up a prescription, check to see if your pharmacy offers touchless services like drive-thru, curbside pickup or mail-order delivery. You can also ask your doctor if it’s safe for them to prescribe a larger supply than normal, so you won’t need to refill the prescription as often.

For cancer patients in particular, we are strong advocates for moving forward with your care in a timely and safe manner. In some cases, this may be as simple as a phone call to your physician, who determines that a delay in treatment is appropriate. Others may need to avoid delays in cancer treatment. Provision CARES Proton Therapy offers both in-person and telehealth consultations to help cancer patients make an informed decision about the timeliness of their treatment.

To learn more about Provision’s telehealth program, please read our Telehealth Frequently Asked Questions.

2. Practice preventive actions

If you decide to visit your doctor in person, there a few simple things you can do while out in public to protect yourself and others from COVID-19. These include washing your hands often, social distancing, and covering your mouth and nose with a cloth face cover. We encourage you to review the CDC’s guidelines on face coverings to better understand when and how to wear them, as well as which groups of people should not wear them.

All Provision CARES Proton Therapy centers have implemented preventive safety measures to protect the health and safety of our patients, employees and visitors. When you come to Provision for an in-person consultation, treatment or follow-up, you can rest assured we are doing everything we can to keep you safe. This includes limiting the number of visitors allowed with each patient and pre-screening everyone who enters our facilities.

To learn more about our pandemic response, please read our COVID-19 Frequently Asked Questions.

3. Keep a few items handy

When visiting your doctor, the CDC guidelines suggest having the following items on hand:

  • Cloth face covering
  • Tissues (to help you avoid touching your face)
  • Hand sanitizer (should contain at least 60% alcohol)

For the safety of patients, employees and visitors, many doctor’s offices now require you to wear a face covering inside their facilities. This is true for all Provision CARES Proton Therapy centers. If you do not have your own face covering, we will be happy to provide one for you upon arrival. As an added precaution and to encourage frequent handwashing, we have also increased monitoring and refilling of soap and hand sanitizer dispensers throughout our centers.

TIPS FOR OTHER ESSENTIAL TRIPS

Aside from medical visits, there are plenty of other reasons to leave your home. Whether it’s running errands, dining out, or going to the park, the CDC has guidelines for just about every situation.

Most importantly, if you are sick or have symptoms of COVID-19, which include a fever, cough or shortness of break, the CDC recommends you stay home and avoid in-person contact with others. Try taking advantage of delivery services and online options for common errands like grocery shopping, take-out dining or banking.

Some of the CDC’s other guidelines are universal no matter what your reason for going out, including wearing a cloth face covering, social distancing, using hand sanitizer while out and about, and washing your hands when you get home.

For more specific guidelines for certain situations, please visit the links below:

Running Errands: This set of guidelines includes grocery shopping, deliveries and takeout, banking and getting gas.

Personal and Social Activities: These guidelines cover dining out, hosting a gathering, using a fitness center, going to a salon, visiting a library, and traveling overnight.

Using Transportation: This includes guidelines for the use of public transit, rideshare/taxis, and personal vehicles.

Visiting Parks and Recreational Facilities: This section has some helpful Do’s and Don’ts if you plan to visit national, state, or local parks, as well as beaches, pools, and playgrounds.

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As part of the Provision CARES Cancer Network, Provision CARES Proton Therapy has locations in Knoxville, Tenn. and Nashville, Tenn. If you or someone you know has cancer, we encourage you to call a treatment center near you. One of our Cancer Care Experts can speak to you about your specific diagnosis and help determine if proton therapy may be right for you.

 

Male cancer patient using telehealth

Telehealth can help cancer patients during coronavirus pandemic

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Trying to navigate your cancer care journey is challenging enough without the added stress of a global pandemic.  Normally, you would schedule an in-person consultation with a physician to discuss your treatment options. Understandably though, many cancer patients now have reservations about going out in public during the coronavirus pandemic. Thankfully, telehealth provides a safe way for someone with cancer to continue moving forward with their care in a timely manner.

Provision CARES Proton Therapy implemented an expanded telehealth program in March 2020. This has allowed us to continue helping cancer patients in a safe environment, while also limiting the number of people at our centers. Since March, our physicians have conducted many telehealth consultations and virtual follow-up appointments. Our telehealth program allows someone who has been recently diagnosed with cancer to remain at home and speak directly to a physician through a video connection about their diagnosis, treatment options and next steps.  Our Cancer Care Experts can help patients through this process.

CANCER CARE PROVIDERS TURN TO TECHNOLOGY

The coronavirus pandemic has changed many aspects of the healthcare industry. When the outbreak began to gain momentum in the United States, hospitals made operational changes to accommodate a potential influx of COVID-19 patients. Many general practitioners and specialists began to postpone well-visits and elective procedures. Specialty healthcare providers, including cancer treatment centers, also made adjustments to keep their patients, employees and visitors safe. Many of those providers, including Provision CARES Proton Therapy, turned to technology, broadening their ability to provide cancer care through the use of telehealth.

A recent survey indicated nearly half of all physicians are now communicating with patients through telemedicine, a stark rise from just two years ago. The survey, conducted by Merritt Hawkins, a physician search firm, in collaboration with The Physicians Foundation, sought to learn how COVID-19 is impacting physicians and how they are responding. It found that 48 percent of physicians are using telemedicine with patients. A similar study by The Physicians Foundation in 2018 had that number at just 18 percent.

The increase in telehealth usage was aided further after the Centers for Medicare & Medicaid Services announced they would broaden access to Medicare telehealth services as part of the federal government’s emergency pandemic response.

CANCER & TELEHEALTH FROM A PHYSICIAN’S PERSPECTIVE

James Gray, MD, FACRO, Medical Director at Provision CARES Proton Therapy NashvilleSince the use of telehealth for medical appointments is becoming more common, we’re providing some firsthand insight into how it works and why it’s such a valuable tool for cancer patients. We asked the medical director of Provision CARES Proton Therapy Nashville, Dr. James Gray, a few questions about his experience with telehealth during the pandemic. Dr. Gray is a board-certified radiation oncologist who has spent 30 years studying cancer and helping patients navigate their cancer care journey.

What are your general thoughts on the use of telehealth for cancer care?

“I believe telehealth substantially contributes to our ability to communicate with patients.  While this applies across all areas of healthcare, it particularly applies to services which are restricted or to which there is limited access.  Proton therapy is a prime example of this.  I can interact with and advise patients who might not otherwise find it reasonable or even possible to travel to our center, or any other proton center.  Such patients may find that proton therapy has possible benefits for their circumstance and might make the trip worthwhile.”

What kind of feedback have you heard from cancer patients who’ve used telehealth?

“Generally good.  Telehealth allows us to help prevent a delay in the cancer patient’s process. As long as an in-person assessment is not necessary, then a telehealth consult allows me to counsel a patient quite well based on medical records and images forwarded to us in advance.  If equally feasible, an in-person visit is still superior for this communication, but a telehealth visit allows me to get the message across and answer the patient’s questions.”

What would you tell a patient who’s nervous about trying a telehealth appointment?

“I reassure the patient and family members that the telehealth visit can start the process of managing their cancer, but more interactions will follow in order to answer subsequent questions and direct further workup of their disease.  If the reason the patient feels nervous or uncomfortable is simply a technology concern, we can have our administrative staff reach out to them and their family to provide assistance.”

As a doctor, how has telehealth helped you during the coronavirus pandemic?

“It allows me to interact with more patients, and in a more timely manner, than I otherwise could due to visitation restrictions, or perhaps just logistics of travel for the patient.  I receive gratification from counseling patients through a rough time, always hoping to alleviate concerns and fears about issues they don’t understand and taking away some of the uncertainty of their next steps.”

Are there other ways cancer care providers are taking advantage of technology during the pandemic?

“Besides avoiding unnecessary contact between care providers and patients, physicians have suspended our in-person meetings called tumor boards or tumor conferences.  But there is a silver lining to this change because we have been forced to become better at virtual meetings, allowing us to exchange ideas and recommendations through audio/visual software.  Again, in-person meetings will likely always be preferable when reasonable, but the ability to attend the meeting virtually from your office or home has been given a big boost during this time.  Ultimately, comfort with this type of meeting attendance makes the meeting more accessible.  And the more we interact, the better we explore all options for our patients.”


To learn more about Dr. Gray and the other board-certified radiation oncologists at Provision CARES Proton Therapy, please visit Our Physicians page. If you are interested in learning more about proton therapy or scheduling a telehealth consultation, please call the Treatment Location closest to you and speak with one of our Cancer Care Experts.