Prostate Cancer Treatment

The diagnosis is prostate cancer. Should I wait and see or undergo treatment?

Many men face the difficult decision of whether to promptly undergo treatment for prostate cancer or simply wait and see whether the disease progresses at all.

The decision is especially difficult because patients are naturally afraid of missing the right moment to intervene.

The fact is, however, that many prostate tumors do not need to be treated because the patient is far more likely to die at some time during the next several years for some other reason. In any case, it is clearly essential to examine the available information and make an informed decision about whether or not to forego prostate cancer treatment.

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Active Surveillance

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MRI scan showing a conspicious lesion

Patients who elect to forego treatment after consulting with their doctors are generally advised to adhere to a regimen of active surveillance, involving regular checkups to assess the progress of the tumor. The advantage to this strategy is that it allows patients who are unlikely to suffer any significant consequences as a result of having prostate cancer to avoid the discomfort and other risks associated with treatment.

As the most conservative form of prostate cancer treatment, active surveillance is only suitable for patients whose tumors exhibit a low Gleason score (i.e. reduced potential for growth and spreading). Moreover, the size and position of the tumor are also decisive factors. Tumors that are large or close to the prostate capsule are associated with an increased risk of capsular penetration and the spread of the disease.

These factors can be reliably assessed using magnetic resonance imaging (MRI), which enables your doctor to detect and determine the extent and location of any conspicuous lesions in the prostate gland. If any such conspicuous areas of tissue are detected and cancer is confirmed via MRI-guided biopsy, your doctor will determine the tumor’s Gleason score and consider the tumor’s exact location before making a proposal as to the most appropriate form of treatment.

MRI Monitoring

If the Gleason score is low, the tumor is small and the location of the tumor is not near the capsule, then active surveillance may represent a reasonable alternative to undergoing surgery and facing possible side effects such as impotence and incontinence. In this case, MRI will be used to examine the tumor at regular intervals. The MRI scans from each examination can then be compared to determine whether any significant changes have taken place. MRI is currently the best imaging procedure available for monitoring tumor development. In addition MRI examinations, blood samples will be taken periodically to determine whether any significant changes in the patient’s PSA level will have to be considered.

Active surveillance is naturally only an option for patients who have no significant symptoms.

The Conventional Approach

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Template for 12-sample transrectal needle biopsy

The conventional approach to determining whether a patient is a suitable candidate for treatment involving active surveillance includes the following two procedures:

  • Transrectal needle biopsy
  • PSA testing

The major disadvantage of transrectal needle biopsy is that tissue samples are removed from the prostate without first determining whether any conspicuous tissue changes are present, let alone the exact location of any such lesions. Moreover, if a tumor is detected, the doctor is often confronted by the difficult task of evaluating its extent, its location in relation to the capsule and whether any other tumors are present that were not detected because their location did not correspond to one of the reference locations on the template.

It is also more difficult to track the development of a tumor using this technique because ultrasound does not offer clear and reliable images that can be used for purposes of comparison. The doctor is therefore in a position of having to rely on PSA testing and additional biopsies that do not indicate whether a tumor has spread in the direction of the capsule.

Active Surveillance Survival Rates

Active surveillance as a special form of prostate cancer treatment is a viable alternative to prostate surgery. Indeed, survival rates for the patients who opt for active surveillance are comparable to those for patients who undergo surgery despite the fact that their tumors meet the criteria for active surveillance. One study showed no additional tumor growth in 65% of 299 enrolled patients 8 years after the original diagnosis. Surgical intervention became necessary in 22% of the patients within the 8-year period. The overall survival rate was 99.3% at 8 years. A total of 12% of the patients elected to discontinue the active surveillance in favor of surgery.

The significantly improved means of diagnosis and surveillance available today offer patients who opt for active surveillance a greater degree of security. Patients who have been diagnosed with prostate cancer are therefore advised to consider their options carefully. After all, they may be able to avoid unnecessary treatment and the risks associated with it.

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