Feature: Prostate Cancer — Is ‘Watchful Waiting’ for You?
If you were diagnosed with cancer, you would expect your doctor to recommend immediate treatment. But that’s not always the case with prostate cancer. In fact, some men diagnosed with prostate cancer may be better off delaying treatment for many years — if not for the rest of their lives.
Delaying treatment while keeping a close eye on cancer is called active surveillance. This approach allows certain prostate cancer patients to enjoy a better quality of life because they can delay or avoid urinary incontinence or erectile dysfunction. Incontinence and ED are side effects from surgically removing the prostate gland or treating it with radiation or cryotherapy (freezing cancerous tissue to destroy it).
Unlikely to be imminent danger
The best candidates for active surveillance are generally older men with low-grade cancer confined to the prostate gland. Because prostate cancer is typically a slow-growing cancer, these men most likely would die of some other cause before the prostate cancer would become a problem.
“If a person’s life expectancy is less than 10 years, it is unlikely that prostate cancer will harm him,” says J. Stephen Jones, MD, FACS, Chairman of the Department of Regional Urology. He adds that sometimes even 20 years can go by without incident.
Keeping close watch
Dr. Jones stresses that active surveillance is not a period of ignoring the cancer. Rather, it is “the decision to address it when it’s time to address it — if that time ever comes.” By closely monitoring the cancer, the physician and patient can decide if and when it’s time to treat it.
The cancer is carefully watched through biopsies and MRIs performed on a regular basis. The frequency of the testing varies greatly from patient to patient depending on each individual situation. If and when the cancer grows or becomes more aggressive, the patient can undergo treatment.
Candidates carefully chosen
Roughly one-third of prostate cancer patients at Cleveland Clinic are considered for active surveillance. But, Dr. Jones says, a single initial biopsy is not enough to make the call.
“We don’t regard patients as being under active surveillance until we qualify them as being under active surveillance,” he says. “This means our patients have a second biopsy and MRI scan. Someone initially diagnosed with low-grade cancer may be a candidate, but we need to find out.”
He points out that about one-third of patients often actually have worse disease than initially believed — something that can be determined only with a second biopsy.
Knowledge increases comfort level
Patients may be relieved when told they can delay treatment — but this period of watchful waiting after being diagnosed with cancer does make some patients and families uncomfortable.
Dr. Jones allays fears by educating patients and families about prostate cancer and helping them to truly understand their risks, and the outcomes of the disease and its treatment.
Some patients hear the word “cancer” and panic, he says, but death from prostate cancer in the short term is rare.
Tip: Lighten Your Load – Don’t Walk With Weights
Adding hand or ankle weights may seem to give a strength-building boost to your walking routine but can be harmful. Strapping on light weights won’t burn significantly more calories, and swinging heavier ones can damage shoulder, elbow, hip and knee joints. Put the weights aside until you get home. To add difficulty to a walking routine, tackle hills or increase your speed instead.
Be Well – September 2011 Issue
Feature: Weight Loss – A Happy Accident on the Road to Fitness
An estimated two-thirds of Americans are overweight or obese. But for true health, we need to consider more than just the number on the scale. We need to consider fitness.
Fitness means different things to different people, says Cleveland Clinic exercise physiologist Heather Nettle, MA. Some define it as being able to function physically. Others define it as being athletic and strong.
To Ms. Nettle, the nature of fitness changes as we age. Strength and endurance, among the most important aspects of fitness, naturally diminish over time, and flexibility and balance — aspects of fitness that we may take for granted — become increasingly important.
More than the battle of the bulge
It’s easy to put on pounds as we age and our metabolisms slow down. But “weight isn’t an end-all, be-all when it comes to fitness,” says Ms. Nettle. “If you have a little extra weight but are taking steps toward being more physically fit, you’re doing the right thing. Weight loss is just a happy accident in the process of achieving a healthy lifestyle.”
When it comes to fitness, it’s important to be realistic about the effects of aging on mobility and exercise — but that shouldn’t stop your exercise efforts completely. Make regular physical activity a routine. “Everyone should be doing some form of cardio and strength training,” she says. “Walking is a great place to start.”
With regard to weight loss, a strict or unreasonable diet just isn’t part of a healthy equation. To be physically active, your body needs plenty of fuel. “Food is an ergogenic aid for exercise performance — it helps aid performance just like when you put gas in a car to make the car work,” explains Ms. Nettle. “You need the right nutrition to perform physically.”
Comparing your progress in losing weight and becoming fit with anyone else’s is an easy trap to fall into. For example, Ms. Nettle often sees husbands and wives vying with one another to make progress — but comparisons are unreasonable. “It is sensible to make general comparisons with others who are the same age and gender,” she says, “However, genetic factors cause variance.”
That’s why you can’t always tell if someone is healthy or fit by their physical appearance. People who are “skinny-fat” are naturally thin but not very active. People who are “husky-fit” carry extra weight but lead a healthy lifestyle.
Realizing what fitness can do
Sedentary behavior — not weight alone— is the real measure of disease risk, says Ms. Nettle. So the best way to lower your risk of disease is to get moving. The benefits of physical activity are seemingly endless:
- Reduced risk of diabetes
- Lower risk of heart disease
- Reduced risks of prostate, breast and colon cancers
- Greater mobility
- Greater sense of health and well-being
- Higher quality of life with aging
It’s never too late to work on and improve your physical fitness, says Ms. Nettle. Let weight loss be an afterthought. With a healthy lifestyle, including healthy diet and exercise, weight can go where it’s supposed to.
Be Well – September 2011 Issue
Free Guide: Parkinson’s & Other Movement Disorders
From the well-known Parkinson’s disease to the lesser-known essential tremor and dystonia, movement disorders can be especially tough to live with because their symptoms are so visible. Learn all that our movement disorders specialists can do to manage these disorders today.
Recipe: Grilled Chicken & Vegetable Pasta Toss
Get one last use out of your grill with this light, one-dish meal. Using whole wheat pasta and fresh vegetables makes it high in fiber, and substituting a low-fat for a full-fat dressing cuts both fat and calories. Be creative, and use any vegetables in season that you have on hand.
4 boneless, skinless chicken breast halves (3 ounces each, about 12 ounces total)
½ zucchini, cut in half lengthwise
½ medium red bell pepper, quartered
½ medium eggplant, quartered
2 Portobello mushroom caps, halved
1 cup (one 8-ounce bottle) low-fat Italian dressing
6 ounces uncooked whole wheat linguine
¼ cup freshly grated Parmesan cheese
- Place chicken and vegetables in a heavy-duty resealable plastic bag. Add ½ cup of the salad dressing. Turn to coat. Close bag; refrigerate at least one hour, turning chicken once.
- Heat grill, then spray grill rack with nonstick cooking spray. Drain chicken and vegetables, reserving marinade. Place chicken on gas grill over medium heat or on charcoal grill 4 to 6 inches from coals. Cook 15 to 20 minutes or until chicken is fork-tender and juices run clear, turning once and brushing frequently with reserved marinade.
- While chicken is cooking, place vegetables cut-side down next to the chicken on the grill. Cook 14 to 18 minutes or until tender, turning once and brushing frequently with reserved marinade. Discard any remaining marinade.
- Meanwhile, cook linguine according to package directions. Drain and toss with remaining ½ cup of salad dressing.
- Remove chicken and vegetables from grill. Thinly slice vegetables; toss with linguine mixture. Slice chicken breasts crosswise, and fan slices over pasta and vegetables. Sprinkle with cheese and serve immediately.
Makes 4 servings
Per serving: (One chicken breast plus 1 cup pasta and vegetables)
Fat: 12 g
Saturated fat: 2 g
Protein: 37 g
Carbohydrates: 44 g
Dietary fiber: 9 g
Sugar: 5 g
Cholesterol: 77 mg
Sodium: 490 mg
Potassium: 822 mg
Recipe from our Children’s Hospital Pediatric Nutrition Support Team
Be Well – September 2011 Issue
Let's Move It! Free Mobile App
Let Cleveland Clinic and your mobile phone keep you motivated. More than just a pedometer, our free mobile app offers walking challenges, a calorie tracker and videos to encourage and inspire.