When a man learns to have prostate cancer, his physical urge is usually to want to get rid of him immediately. However, not all cancers of the prostate are themselves, nor equally aggressive.
In fact, sometimes the best option is for the patient to do nothing, in addition to undergoing regular examinations to monitor the course of his illness.
This tactic is called active or active monitoring and is recommended in low-risk tumors, ie when:
- The volume is very small and confined within the prostate,
- The tumor grows very slowly, and
- There is little risk of growing further or spreading to the body or costing the patient's life.
As explained by the chairman of the Hellenic Urological Society, Dr. Iraklis Poulias, director of the Urology Clinic of Korgialenios Benakiou EOC Hospital, it is estimated that one in three cases of prostate cancer do not require surgery or other treatment, but monitoring the patient with systematic examinations. However, the choice of patients to whom active follow-up is proposed should be carefully considered.
"Their choice is based on specific factors such as age, tumor size, cancer stage, and the Gleason score obtained with the biopsy, and shows how aggressive the tumor is," he explains. "In addition, the PSA should be less than 10 ng / ml."
Gleason score or score is a 10-step system that shows how much the prostate cells have lost their structure. The more aggressive the cancer, the more unstable (undifferentiated) the cells and the higher the score.
In summary, Gleason scores 2 to 7 mean small and moderate aggressive cancer, while those over 8 indicate a particularly aggressive tumor.
Correspondingly, staging of prostate cancer is based on whether and how it has spread. In general, Stage 1 and 2 tumors remain within the prostate gland, Stage 3 has begun to spread out of it, while Stage 4 has metastasized to other organs or parts of the pelvis.
"The older the patient is, and the lower the Gleason score, the more likely he is not to be at risk if he / she is not treated, because the calculated survival expectancy also plays a role," Dr Poulia continues. "For example, active monitoring is often recommended in patients over 65-70 years of age who have a Gleason score of 6 or lower, but it will hardly be proposed to a 50-point score with Gleason score 6. In addition, tumors should be confined within the prostate, be at a stage of 1 or at most 2 for active monitoring. "
Active monitoring may also be a suitable option for men with limited life expectancy, even if the results in the above examinations are not favorable.
It may also be the appropriate option for men who experience additional serious health problems such as heavy heart disease, undiagnosed diabetes or persistent hypertension when their doctors find it preferable to avoid first-line treatment for cancer.
The exams
Although active monitoring is not a treatment in the classical sense of the term, it is basically a therapeutic approach because "it is not the same as doing nothing to the patient," Dr Poulia said. "The frequent examinations are done to monitor the absence of any changes in the volume that will make it more aggressive, so we should intervene with surgery, radiotherapy or medication."
But what is the active monitoring? "Essentially it involves regular measurement of PSA levels, finger test and repeat biopsy," says Dr. Poulias. "Depending on the incident, PSA is recommended once or twice a year (sometimes more often in the first year of follow-up), a fingerprint test at least once a year, and a repeat biopsy every 1-3 years. As time passes, biopsies can be done at less frequent intervals, while in selected patients over the age of 80 or those who have a life expectancy of less than 5 years, we may even stop monitoring. "
International studies have shown that 50-66% of men undergoing active monitoring do not need treatment during the first 10 years of their cancer diagnosis, according to the American Cancer Institute of the Prostate (PCF).
Therefore, the benefit of monitoring for most men is that they will avoid the treatment for the others that there will be a delay in therapies, which often have side effects that adversely affect the quality of life (eg erectile dysfunction, urinary incontinence, etc.).
However, the great difficulty is to persuade the patient and his relatives that he does not need to be treated, Dr. Poulias points out, "because most people want to have surgery immediately, since they are deeply rooted in the belief that if the cancer does not come out, the patient will die ".
One in seven chances
Prostate cancer is the second most common malignant disease in men (the first is lung cancer). According to the American Cancer Society (ACS), every man has one in seven chances to show him at some point in his life and one in 39 to die from him.
More than 1.1 million cases worldwide are reported annually, while in our country it is estimated that approximately 3,500 are recorded every year.
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