Men on active surveillance may have a new treatment option


The least invasive treatment option for prostate cancer is called active surveillance. Also known as “watchful waiting,” active surveillance is exactly what it says: Follow-up exams that involve a digital rectal exam (DRE) or prostate-specific antigen (PSA) test every three to six months and a prostate biopsy every one to two years. Active surveillance is a viable option for men whose prostate cancer is very slow-growing or considered low to moderate risk and is confined only to the prostate gland. As long as the tumor does not show growth, no other treatment is needed. This helps men avoid more invasive treatments such as surgery or radiation that can come with side effects. 

But, some men may feel anxious about having untreated cancer inside their bodies. While studies have shown active surveillance to be an excellent option for men who meet the criteria, is there any chance of a treatment for men who want added peace of mind knowing something is being done?

The answer to this question appears to be yes for now. Results from a pilot study published in JAMA Oncology suggest that a monotherapy called enzalutamide may be a potential treatment option for men on active surveillance.

Findings from the study

Few studies have looked into pharmacological medications possibly delaying prostate cancer progression in men undergoing active surveillance. Therefore, the objective of this study was to compare the efficacy and safety of enzalutamide monotherapy in men also undergoing active surveillance and in men treated with active surveillance by itself. 

For this study, researchers recruited 227 men from both U.S. and Canadian sites were recruited to participate in two years of follow-up using this drug. Patients eligible for the study had to be at least 18 or older, diagnosed with either low-grade or intermediate-risk localized prostate cancer within six months of screening, and were undergoing active surveillance.  In addition, half of the men were randomized to one year of taking a daily treatment of enzalutamide along with active surveillance, while the other half of the men enrolled in the study did not take the drug. 

The study found that the men treated with enzalutamide tolerated the medication well. If any man did experience side effects from the drug, the most common were fatigue and breast enlargement, which, once treatment was stopped, went away. In addition, compared with men who only did active surveillance, the men on both active surveillance and used enzalutamide, had a significant reduction of prostate cancer progression by 46%. 

Because this is a small pilot study, to get a more accurate picture of enzalutamide’s potential for reducing the likelihood that men on active surveillance will need surgery or radiation, larger and longer-term studies will be necessary. 

In the meantime, men can rest assured that in the future, there is a real possibility that active surveillance will be used along with enzalutamide or another type of drug, helping lower the chance of prostate cancer progression.


Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911. 

Men on active surveillance may have a new treatment option
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Dr. David B. Samadi

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Dr. David B. Samadi