Prostate cancer: Treatment or not?

Active monitoring is an accepted and widely adopted option in the medical community over the past 10 years as a way to reduce unnecessary treatment of prostate cancer.

Active monitoring is an accepted and widely adopted option in the medical community over the past 10 years as a way to reduce unnecessary treatment of prostate cancer.

Clark Howard is in Shanghai on a business trip in 2009, receiving a call from his wife, tearful and miserable. A biopsy showed Howard, then 53 years old, had prostate cancer. When he returned home in Atlanta, the doctor suggested that he have surgery to remove the prostate or radiotherapy, specifying a standard diagnosis at that time.

But in Shanghai, Howard read a series of articles in medical journals about prostate cancer. Articles suggest that for some patients with prostate cancer in Europe, treatment may not be needed.

"You can still monitor whether you have cancer, instead of" jumping into the treatment "immediately , " he said. To the frustration of the doctor who planned to operate for him, Howard chose an approach called " active surveillance".

It is an accepted and widely adopted option in the medical community over the past 10 years as a way to reduce the need for treatment of unnecessary prostate cancer, Ballentine Carter, a specialist doctor. Cancer department at the Johns Hopkins Hospital in Baltimore said.

Picture 1 of Prostate cancer: Treatment or not?

Picture 1 of Prostate cancer: Treatment or not?



Positive monitoring worked for Howard: Ten years after diagnosis, his prostate cancer did not spread, and the doctor said he was in good health. Howard is no exception. In 2016, New England Medical Jourrnal published a 10-year study of more than 1,643 men aged 50 to 69 diagnosed with prostate cancer.

The researchers found no significant difference in mortality rates between those who were actively monitored and those who had prostate or radiotherapy surgery."Based on this data, active surveillance is currently the most common way to manage newly diagnosed low-grade cancer patients in the United States , " said Dr. Eric A. Klein, chairman of the Glickman Urology Institute at Cleveland Hospital.

Here are the potential side effects that patients may experience when undergoing typical treatment for prostate cancer:

Side effects of prostate surgery:

  • Erectile dysfunction.
  • Urinary problems like urinary incontinence.
  • Bad reaction to anesthesia.
  • Bleeding in.
  • Thrombosis
  • Infection.

Side effects of radiation on prostate cancer:

  • Erectile dysfunction.
  • Stimulation of bladder and urinary tract.
  • Bowel symptoms.

Prostate cancer is not working

In the United States, there are nearly 175,000 new cases of prostate cancer each year. About 60% are diagnosed in men 65 years and older and the occurrence of prostate cancer in men under 40 is very rare. Prostate cancer is the second leading cause of cancer death in American men, just behind lung cancer. About 1 in 9 men will have a diagnosis of prostate cancer in their lifetime. In general, more than 30% of men diagnosed "lazy" prostate cancer, said Jonathan W. Simons, cancer specialist, chairman and chief executive of prostate cancer fund. . That means cancer is basically incapable of metastasis and does not become life-threatening. Therefore, typical treatments for prostate cancer - radiotherapy or surgery to remove the prostate - are not necessary.

Which patients are most suitable for active monitoring?

Doctors use a scoring system to determine which prostate cancer patients have a lower risk of spreading cancer and who should choose active monitoring. Usually, a urologist will perform a biopsy to take small tissue samples in different areas of the prostate, and then the pathologist will determine the extent of the cancer (if any). Degree is a way to determine the extent of cancer growth on a scale called Gleason score . The Gleason score ranges from 6 to 10, with the higher the score, the more aggressive the cancer is.

Doctor Simons explains: "The Gleason score from 7 to 10 shows that the cancer is more advanced and has a higher risk of spreading than Gleason 6. The patient should talk to the doctor about results-based decision making. biopsy and other clinical factors, such as family history of cancer " . Patients with a Gleason score of 6 or less should talk to their doctor about whether active monitoring is a viable option for them.

Active monitoring does not mean doing nothing. This approach means that patients need to see a urologist once or twice a year to test for PSA in the blood (screening for prostate-specific antigens) and rectal visits. Biopsy of the prostate gland should be performed once every five to five years.

"Positive monitoring means you can't miss a doctor's appointment," said BS. Simons said. For patients who are actively monitored, the concern is not that prostate cancer will become more advanced, but that people with low prostate cancer are at risk of developing a form of prostate cancer. Other paralysis, "aggressive" . "We don't want to be over-treated and we don't want to miss the second cancer," he said. People at higher risk of prostate cancer - such as patients with a family history of cancer - should talk to their doctor about any additional follow-up measures they need.

MRI helps monitor prostate cancer

Some doctors use MRI as part of active monitoring. For example, doctors at Johns Hopkins Hospital often give prostate cancer patients an active MRI surveillance every 2-4 years. Using patient data - PSA and biopsy results - doctors have developed an algorithm to predict the trajectory of cancer in patients. This method is similar to the way meteorologists use data and algorithms to predict storms. Many cancer centers also use blood and urine tests and examine tumor genes to evaluate cancer.

It is understandable to diagnose prostate cancer, but that is not the reason to panic. It is important for people who have a diagnosis to do the necessary tests to determine their level of growth and to talk to their doctor to decide whether treatment for prostate cancer is needed. The first step is to determine whether treatment is necessary, and if so, which method is best for the individual patient. There is a very large proportion of people who are diagnosed with the disease but may not treat it and remain safe.

Dr. Edward M. Schaeffer, urologist at Feinberg School of Medicine, Northwestern University, agrees. "Positive monitoring has been shown to be a safe and effective way to manage male patients with a small amount of minimal growth of prostate cancer," he said."While under careful supervision, the risk of developing cancer is less than 0.5% in 10 years and the risk of death is almost zero."

Here are three things to remember about active monitoring:

  • More than one-third of men diagnosed with prostate cancer can control the disease with positive monitoring.
  • Active monitoring is a continuous process that involves monitoring patients with different tests.
  • When done carefully, positive monitoring is safe and progression to spreading cancer is rare.

Breakthrough in the treatment of prostate cancer

It was possible to classify prostate cancer