Many Patients Opting for Monitoring and Lifestyle Interventions Over Surgery

Get rid of it. That's what many men want to do when they find out they have prostate cancer. They want it gone, either through surgery or other treatments, even though such options could cost them the ability to control their bladder or have an erection.

Charles Trevino is going another route — active surveillance. In this growing trend, doctors closely monitor a patient's disease while encouraging men to make lifestyle changes that could slow the progression of their disease.

Active surveillance patient Charles Trevino remains physically active to decrease his risk of disease progression.

In the past five years, advances in prostate cancer have shown that many forms of the disease are like Trevino's – slow-growing and not life-threatening. As a result, oncologists in the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute often encourage patients not to rush to surgery. However, this is in sharp contrast to conventional medical advice, which often has cancer patients heading to surgery or radiation therapy immediately after diagnosis.

This traditional recommendation reigned true for Trevino. The first doctors he saw suggested prostatectomy, a sometimes-complex surgical removal of the prostate. Trevino's wife and children were behind the idea of surgery, but Trevino was hesitant.

"After 30 years of marriage, six children and seven grandchildren, I thought I was prepared for anything, but prostate cancer came as a shock and as a source of confusion," said Trevino, 65, a retired government affairs representative and former educator. "The initial stages of diagnosis were confusing because most medical professionals immediately suggested prostatectomy surgery. I was ready for information; I wasn't ready for someone to make a treatment decision for me. Being my own advocate was important and so was being informed of all of my options."

After expressing this frustration to his primary care physician, Trevino was referred to Hyung Lae Kim, MD, co-medical director of the Urologic Oncology Program at Cedars-Sinai.

Charles Trevino and his urologic oncologist, Hyung Kim, MD, discuss the latest advancements in active surveillance research and care.

"Prior to meeting Dr. Kim, information was being thrown at me from every angle, with little to no explanation or guidance — I felt as though I was learning a foreign language," Trevino said. "Dr. Kim spent nearly an hour with me during our first meeting explaining the basics of prostate cancer, my diagnosis and clearly identifying my treatment options, including active surveillance. That was the careful attention and explanation I had been seeking."

This initial meeting provided confidence to not only Trevino, but his wife and children as well. Then, feeling informed and empowered, he enrolled in an active surveillance regimen led by Kim.

"Active surveillance is the merging of watchful waiting and active management into a program that is interactive for the patient," Kim said. "The program allows a man diagnosed with prostate cancer to monitor his disease and have the highest quality of life possible while delaying or even completely avoiding invasive treatments."

Men in the Cedars-Sinai surveillance program undergo routine monitoring that includes prostate-specific antigen (PSA) tests, rectal exams, periodic biopsies, imaging of the prostate and molecular and genetic testing.

If a man's disease progresses to the point where it becomes a threat to life, patients can choose to undergo one of the many treatment options available to them at Cedars-Sinai.

In addition to an active surveillance regimen, Trevino enrolled in a clinical trial known as the Men's Eating And Living (MEAL) study, which aims to understand how diet might affect prostate cancer outcomes.

The MEAL study investigates whether a plant-based diet of colorful vegetables, along with a healthy lifestyle, can help decrease disease progression and anxiety in men being treated with active surveillance.

"The latest thinking is that lifestyle changes that are good for the heart are also good for cancer management," Kim said.

After a diagnosis of low-grade prostate cancer, Charles Trevino is eating healthier and enrolled in a diet-based clinical study.

Thanks to this newer philosophy and a dedicated team of cancer specialists, Trevino has not been affected by the many possible side effects of treatment and surgery. For him, a healthy and active lifestyle, coupled with active surveillance, provides both comfort and discipline to his life.

Today, Trevino works out regularly at the gym and takes long, brisk walks around his favorite Los Angeles-area spot — the Rose Bowl in Pasadena — and consumes a balanced diet, including leafy, fresh greens, very few red meats and alcohol in moderation.

And now, newly retired, Trevino can spend more time with his wife enjoying a long-time hobby — salsa dancing. As they sway to their favorite song by Orquesta La Palabra, the two can relish in the moment and celebrate life and love.

"Active surveillance doesn't mean you're giving up on your disease," Trevino said. "Active surveillance is meant to change the way you live and the way in which you appreciate your life. These programs should make a man eat healthier, drop the bad lifestyle habits and live life more fully with his family and loved ones."