Active surveillance
Posted by: rlotenfoe in Untagged on
May 31, 2009
One of the latest discussion points in prostate cancer is the concept of "active surveillance". In light of 2 recent studies that suggest that many men are unneccesarily treated for prostate cancer, there have been many inquiries at the office.
Active surveillance is an option for men who are found to have an indolent cancer. The definition of an indolent cancer varies greatly among different institutions. An acceptable definition seems to be: not more than 2 cores positive on a standard 8 to 12 core biopsy, not more than 50 percent involvement of each core, no Gleason grade 4 or 5, and PSA less than 10.
Following these criteria, still a significant amount of men will turn out to have a progression of their cancer and/or have treatment. In a few cases men actually progressed to metastatic disease. At the same time every protocol for active surveillance recommends a second biopsy within a year to confirm the previous findings and/or to evaluate for progression. Then there is also the psychological burden of knowing that you have a cancer, and wondering what will happen.
Currently there is no reliable way to predict who will progress, and who will eventually need treatment. Currently non-traditional diagnostic methods such as PCA-3, 3D mapping biopsy, MRI Spectroscopy and Doppler ultrasound may eventually aid urologists in determining which cancers are truly indolent and will not need treatment.
In view of the above, when deciding to have active treatment for a small, low risk cancer, it is important to realize that almost any treatment will succesfully get rid of the disease. However, it is also important to realize that certain treatments are more invasive and some will have more side effects than others. Sonablate HIFU in these cases will treat the cancer effectively in the vast majority of men while maintaining potency in 90 percent of cases, and maintaining continence in up to 99 percent of men. This is better than any other treatment available at this time. Sonablate HIFU is minimally invasive (only a 4 mm incision), usually without blood loss, creates minimal discomfort and is an outpatient same day procedure.
Active surveillance is an option for men who are found to have an indolent cancer. The definition of an indolent cancer varies greatly among different institutions. An acceptable definition seems to be: not more than 2 cores positive on a standard 8 to 12 core biopsy, not more than 50 percent involvement of each core, no Gleason grade 4 or 5, and PSA less than 10.
Following these criteria, still a significant amount of men will turn out to have a progression of their cancer and/or have treatment. In a few cases men actually progressed to metastatic disease. At the same time every protocol for active surveillance recommends a second biopsy within a year to confirm the previous findings and/or to evaluate for progression. Then there is also the psychological burden of knowing that you have a cancer, and wondering what will happen.
Currently there is no reliable way to predict who will progress, and who will eventually need treatment. Currently non-traditional diagnostic methods such as PCA-3, 3D mapping biopsy, MRI Spectroscopy and Doppler ultrasound may eventually aid urologists in determining which cancers are truly indolent and will not need treatment.
In view of the above, when deciding to have active treatment for a small, low risk cancer, it is important to realize that almost any treatment will succesfully get rid of the disease. However, it is also important to realize that certain treatments are more invasive and some will have more side effects than others. Sonablate HIFU in these cases will treat the cancer effectively in the vast majority of men while maintaining potency in 90 percent of cases, and maintaining continence in up to 99 percent of men. This is better than any other treatment available at this time. Sonablate HIFU is minimally invasive (only a 4 mm incision), usually without blood loss, creates minimal discomfort and is an outpatient same day procedure.