” Active” Active Surveillance in Prostate Cancer

Dr. Charles Meakin
Dr. Charles Meakin

As Chief Medical Officer of Care Oncology, I have witnessed many prostate cancer patients (in the above scenarios) find their way to our metabolic protocol to engage a truly “Active” Active Surveillance strategy.

One of the therapeutic options upon diagnosis of prostate cancer is the prospect of deferring commencement of traditional therapies while one monitors the PSA level. (https://www.nccn.org/patients/guidelines/content/PDF/prostate-patient.pdf).

In line with this, at Care Oncology we have many men who have chosen to start the COC Protocol and ultimately been able to enjoy long periods away from traditional therapy and its side effects and cost. It is possible the protocol is having a favorable impact on proliferation drivers that foster the cancer cell growth reflected in a rising PSA, and we are tracking our cohort over time to analyze this further.

The strategy may be a sensible one since many patients are diagnosed with indolent cancers and at an age where they are likely to have comorbidities. Hence the statement that many men with prostate cancer “die with it, but not from it.”  The first step is identifying the risk category of the prostate cancer (PSA level, Gleason Score, degree of spread etc) versus the anticipated life expectancy of the patient. Once these two characteristics have been evaluated, one can consider which threat is the greatest – the prostate cancer versus the other advancing potential causes of death as men age. The traditional Active Surveillance strategy incorporates frequent PSA  or tumor marker checks as measured in an annual biopsy procedure, which can become very challenging for patients (https://pubmed.ncbi.nlm.nih.gov/28512731/). Generally, about 50% of the patients will transition to some treatment over a ten-year period without any loss of treatment success as compared to immediate treatment with surgery or radiation.

The difficulty with active surveillance is going to bed every night, knowing there may be cancer growing in your body. Some men handle this dilemma better than others, and I have noticed that after one to two years, many say, “Hey Doc, can we go ahead and treat it!”.

In my big cancer center oncology role, during this watchful waiting window, I would frequently put patients on some nutrition and supplements strategies associated with anti-proliferation. In many instances, I would see the PSA reduce or even flatline, resulting in emotional satisfaction for the patients, many of whom reported feeling able to exert some element of direct control over their disease for the first time. Personally, I found management of these patients very rewarding too, as I believe there is a strong likelihood the “active” strategies we deployed also had a positive impact on other existing chronic health conditions  or chronic disease risk factors prevalent in men of a certain age.

The other situation that frequently would come up with similar options and implications is the very common occurrence of PSA failure after attempted curative surgery or radiation (External Beam or Implant). At this unfortunate juncture, men often continue to feel fine. Still, they are tortured by the knowledge that the cancer is growing back and may be a problem at some time in the future, and some new therapies may be necessary despite the initial treatment. This dilemma can be complicated by consideration of therapies such as androgen blockade that can accelerate other chronic comorbidities and impact the quality of life in order to treat an asymptomatic lab value like the rising PSA.

We’re very excited about the encouraging preliminary results we are seeing, so in addition to continuing to audit the outcomes of our own patients at Care Oncology, we have now also begun  approaching large urology  groups to explore initiating the COC metabolic protocol as a  formal study, given the ease of implementation, fundamental affordability of the program and most importantly how empowering it has the potential to be for patients.

Stay strong and curious,

Charles Meakin MD