Page 1 - Active Surveillance for Prostate Cancer
P. 1

Urological Health

                                 Active surveillance

                                 for prostate cancer

        Prostate cancer often is very slow to progress. Some patients with low risk cancer may choose
        close observation with no immediate active treatment.

           he prostate is a gland wrapped around the urethra,     The concept of active surveillance has more recently
        Tthe urine channel, between the bladder and its           been seen as a viable option for men who, for one
        control muscle, the urethral sphincter. Its main function   reason or another, have decided not to undergo
        is to produce part of the semen ejaculated at male        immediate surgery or radiation therapy. Active
        orgasm. Each vas deferens carrying sperm from the         surveillance is not just postponing treatment. For many
        testicles connects to the prostate. The nerves carrying   men who have slow growing or very early cancers,
        signals to produce erections run on either side of the    immediate treatment might not make sense. Instead,
        prostate.                                                 active surveillance allows close monitoring with
                                                                  subsequent treatment if it is decided that the cancer is
                                                                  becoming more concerning. Active surveillance might
             Side view of male lower urinary anatomy              also be a good choice for men who have other serious
                                                                  medical conditions that affect the way they live their
                                                                  lives, or likely to shorten their lifespan.
                                                    Roula Drossis
                                              seminal             Prostate cancer risk
              sphincter                       prostate            It is well known that prostate cancer grows more slowly
                                                                  than others, and that some men are unlikely to get sick
                                              rectum              or die from their disease. Many reports have shown that
              urethra                         erectile            most men in their later years of life have evidence of
                                              nerve               prostate cancer but this latent or dormant cancer may
                                                                  never progress or affect the patient. One large study of
                                                                  men with early, low-risk prostate cancer that were only
                                                                  watched carefully, with no active treatment, showed
                                                                  that the majority did not die from their disease, even after
        Cancer may develop in the prostate from which it can      20 years of follow-up.
        grow into surrounding tissues or spread to other parts
        of the body although most frequently the diagnosis        However, the question of whether your cancer is more
        of prostate cancer is made very early by an elevated      or less aggressive can be difficult to predict. Cancer
        PSA (prostate specific antigen) blood test. Microscopic   aggressiveness can be determined to some degree using
        examination of prostate biopsies confirms the suspicion   available evidence that you have already discussed
        of cancer and allows some prediction of the tumour’s      with your doctor. The ones mostly widely used are
        expected behaviour. This is known as the tumour grade     tumor grade (Gleason score), PSA, and the extent of
        or Gleason score.                                         your tumor (stage). More favorable or low-risk prostate
                                                                  cancer is often described as a Gleason 6 or less, a PSA
        Additional investigations may be performed, when          10 or less, and early stage tumor based on your digital
        necessary, to determine the extent or stage of the        rectal examination (DRE). Intermediate risk cancer
        cancer. Your prostate cancer appears to be confined       includes Gleason score 7, a PSA between 10 to 20 or
        to the prostate, although there is a chance of            more advanced cancer on rectal examination. The
        undetectable, microscopic spread.                         more aggressive the cancer, the higher the risk for early
                                                                  spread to other areas of the body and therefore active
        You have discussed several treatment options with your    surveillance would be less of an appropriate option.
        urologist, including:
        •  Active surveillance (observation without treatment;
          sometimes called watchful),
        •  surgical removal of the prostate, and,
        •  radiation therapy (by external beam or
          implantation of radioactive pellets, brachytherapy).
                                                                                             Continued on next page
        Each option has its own advantages and risks.
   1   2