By Howard Wolinsky
After 30 years, a majority of U.S. patients with low-risk prostate cancer (60%) finally are opting for active surveillance (AS).
It has been an uphill climb for the management technique with close monitoring of the cancer with urologist office visits, PSA blood tests, MRI scans, and biopsies.
When I was diagnosed in 2010, only 6% of us took the then-unbeaten AS path of AS.
Flip that: 94% of my peers in 2010 underwent unnecessary surgery or radiation and suffered side effects, including impotence, incontinence, and bowel issues. Things are better now, “only” 40% go for active treatment,.
Too many in my view, and, increasingly in the view of the everyday urologist.
Now, the U.S. urology community, via the American Urological Association, is shooting for an 80% uptake of AS.
It’s a modest goal.
No one thinks there will be 100% success because of emotional and other issues men face in accepting the notion that we can live with a slow-growing, indolent cancer for many years or even to the end of our lives from other causes,
The 90% solution
We already know that some individual practices in the U.S., regions (the state of Michigan), and entire countries, such as Sweden, Holland, and the U.K. have achieved 90%-plus success rates in men with low-risk prostate cancer.
Each got there in their own way.
(I am organizing a webinar on this in November with case studies where doctors share their secret sauce for AS success. More details soon on “Moving the AS needle.”)
One approach to AS success I am keen on is the “Predict Prostate” model developed by Professor Vincent Gnanapragasam and his team at the University of Cambridge in the U.K.
(Professor Vincent Gnanapragasam)
Predict Prostate provides personalized estimates of the likelihood of prostate cancer death versus other causes of death over a 10-15-year period after a man is newly diagnosed.
Moreover, it also provides an estimated benefit that treatment would give compared to a conservative management approach like AS.
This dual output means that the benefits or not of prostate cancer treatment can be viewed in the context of overall survival and not just prostate cancer survival.
Since introduced in 2019, Predict has been accessed hundreds of times each week. Overall, Predict has been used 50,000 times since launch by patients from 110 countries.
U.S. awareness is low
But, Gnanapragasam added, in the U.S. awareness and use remain low.
The predictive communication tool is not intended for men like me who are already on AS. I’ve been on AS for 12 years—a single Gleason 3+3 core of less than a millimeter was diagnosed in 2010 and never seen again through six biopsies and two MRIs.
Predict is for the newly diagnosed.
You can find it at
It takes only a few minutes to enter data, including your age, PSA, and Gleason score, the usual.
You get results instantly. Share them with your doctor to help chart your course.
Gnanapragasam said, “Predict is only for use at the point of a new diagnosis of prostate cancer and for men where AS and treatment are equally valid options -therefore we would not recommend retrofitting Predict for men already on AS - for example, a man already on AS is a few years older, or may have other illnesses now and so the balance of survival benefit changes.”
Playing pretend with Predict
For story purposes, I pretended I was a newbie at age 63.
Predict gave me an estimate of how I might fare on AS for the following 10 years.
Gnanapragasam played along.
He said: “As a newly diagnosed man you have a 4% benefit from treatment vs conservative management in terms of overall survival (what the model was designed to predict) in that time you have a 28% chance of dying of other causes.”
As Predict Prostate predicted, I survived. I have never been treated, only followed for a dozen years. So I beat the Grim Reaper, so far.
Only two men like me out of 100 with Gleason 6 would die from prostate cancer 10 years after diagnosis.
Nine would die from other causes. I suspect most die from cardiac disease. (So take care of your heart health and your prostate health will follow.)
76% of men like me survive up to the 15-year point.
Gnanapragasam said: “We don’t ever tell a man what to do, but we present these predictions alongside options, and almost invariably a man will choose AS. After all, we can’t say whether a man is in the 4% who would benefit from treatment or the rest who would not.
“Predict is a risk communication tool, and part of what we believe is truly informed decision making in early prostate cancer.”
The urologist said: “In my practice and in many in the U.K. it’s the main gateway to helping men and clinicians understand why their cancer is likely to be indolent, and, hence, AS is appropriate
“Since implementation and use along with other tools AS rates have increased dramatically”
This YouTube explains Predict:
The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care in the U.K and has endorsed the use of Predict Prostate as a decision aid for men with newly diagnosed prostate cancer.
Predict Prostate is also available in four other languages in addition to English.
If you are newly diagnosed with low-risk prostate cancer and trying to decide whether to be treated or monitored, I’d urge you to give predict a spin and consult with your doctor.
Sound good enough for you? Aimed at newly diagnosed, but still interesting.
Ok, I did it. My results say that 77% of men with my stats survive 10 years and 54% survive 15 years.
Someone please remind me to repeat this 11 years.