Integrative Medicine Supports Active Surveillance for Prostate Cancer

The American Cancer Society (ACS) estimates that almost 300,000 men will be diagnosed with prostate cancer in 2024 with more than 35,000 deaths making it the second leading cause of cancer death for men living in the United States. While prostate cancer can be deadly, ACS also reports that most men diagnosed do not die from it as more than 3.3 million men in the United States who have been previously diagnosed, are still alive today.

When prostate cancer is slow-growing and caught early, it can be successfully treated with no treatment, a protocol known as active surveillance, which includes PSA testing, digital rectal exams, and prostate biopsies when necessary. With this subset of patients, surgery, radiation, chemotherapy, and hormone or immunotherapy are not recommended. Some reports indicate that low-risk cancer as defined by a Gleason score of 6 or less with a PSA of less than 10ng/mL represents at least 50 percent of all newly diagnosed prostate cancers.

A new study confirms the efficacy of active surveillance. The researchers followed 2,155 patients with localized prostate cancer and found that ten years after diagnosis, 49 percent were free of cancer progression, less than two percent developed metastatic disease, and less than one percent died of prostate cancer. All the men in the study had no prior treatment and were using active surveillance to manage their cancer.

Active Surveillance Anxiety and Uncertainty

While active surveillance is effective, it can be stressful for some men and may impact adherence.

“Fundamentally, many people are uncomfortable with the thought that they’ve been told they have cancer, but that they’re not going to do anything about it,” says Mohummad Siddiqui, MD, who is an advocate of active surveillance and an associate professor of surgery at the University of Maryland School of Medicine and director of urology for the VA Maryland Health Care System. “Active surveillance is not the same as ignoring the cancer or walking away from it. It’s a very engaged proactive process where you are closely monitoring the person.”

Previous research shows that while men seem to prefer active surveillance, it is associated with more anxiety and uncertainty making it a difficult choice.

“It takes a lot of explanation and coaching to make someone comfortable with it,” said Dr. Siddiqui. “Some people will never be comfortable with it.”

Effective communication appears to be key in enhancing active surveillance adherence. That’s also where an integrative approach may help ease anxiety and encourage better adherence which may lead to better outcomes.

Integrative Support During Active Surveillance

An integrative approach can include a variety of strategies; however, the focus is on foundational advice about diet, lifestyle, and possibly dietary supplements.

According to a 2018 review written by respected integrative oncologist Donald Abrams, MD, these are evidence-based integrative strategies worth considering:

• A plant-based antioxidant-rich diet with an emphasis on cruciferous vegetables, tomatoes, soy, pomegranate, and marine omega 3 fatty acids while avoiding saturated fats and dairy products.
• Physical activity to strengthen bones, improve physical health, and enhance overall wellbeing.
• It is likely prudent to avoid vitamin E and selenium supplements while considering vitamin D3, omega 3, and some nutraceutical-based preparations.
• Recommending mind-body interventions to reduce stress, including mindfulness-based stress reduction and support groups.

A 2022 case report describes this approach as “integrative active surveillance” emphasizing the role that diet, lifestyle, and specific nutrients and herbs can play to help reduce disease severity especially in cases of low-risk, slow glowing, early detected prostate cancer.

This latest study confirms the efficacy of active surveillance. Despite that fact, active surveillance anxiety and compliance remain issues that clinicians should consider. Utilizing an integrative approach to support men utilizing active surveillance may help reduce anxiety, enhance compliance, and improve active surveillance efficacy.