Active surveillance of prostate cancer

Prosztatarák aktív felügyelete

Identifying the incidence and prevalence of prostate cancer increased with widespread prostate-specific antigen testing, as did the length of time that men live with their disease, as compared to the pre prostate-specific antigen era. The stage migration that occurred, with application of curative intervention at an earlier stage, undoubtedly led to a reduction inprostate cancer mortality.

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However, the extent to which this reduction was due to prostate-specific antigen based screening is debatable. Most of the evidence on the outcomes of men that are not treated for prostate cancer comes from those diagnosed in the era prior to prostate cancer screening when the disease was diagnosed at a more advanced state.

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Observational studies[ edit prosztatarák aktív felügyelete The outcomes of men who are not treated for prostate cancer is dependent on cancer grade the higher the grade the more aggressiveprosztatarák aktív felügyelete life expectancy of the patient with the disease, and whether or not the cancer was detected through screening. Thus, older men with a limited life expectancy, particularly if detected through screening, may not live long enough to be harmed by the cancer. The outcomes of men with moderately differentiated Gleason scores and poorly differentiated Gleason scores cancers managed without treatment watchful waitingwas compared in the prostate cancer screening era — and pre prostate cancer screening era prior to Randomized studies[ edit ] The control arm untreated of randomized trials comparing surgery to watchful waiting represents an opportunity for evaluating the natural history of prostate cancer.

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These data suggest that the outcomes for men with low risk disease in the pre PSA era are comparable with those of men today diagnosed with intermediate risk disease.

Rationale for non-curative management of prosztatarák aktív felügyelete cancer[ edit ] PSA based screening and treatment of prostate cancer at prosztatarák aktív felügyelete localized stage can prosztatarák aktív felügyelete prostate cancer death for some men.

Functional outcomes and quality of life after treatment for localized prostate cancer[ edit ] At 15 years after treatment radiotherapy or surgery of localized prostate cancer diagnosed indeclines in urinary, sexual, and bowel function were common. Risks of over treatment of prostate cancer[ edit ] Over diagnosis is the detection of a cancer that would otherwise not have been diagnosed in the lifetime of the host if the detection test e.

Treatment of men who would otherwise not have known about their cancer in the absence of PSA testing and méregtelenítő tapasz talp vélemények are over treated.

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Over treatment exacts a cost to the health care system and potential harm to a patient decrease in quality of lifewith no benefit. Over treatment is most likely to occur when a low grade prostate cancer is detected, especially in an older man.

A disturbing trend has been noted in men with newly diagnosed prostate cancer treated with robotic surgery and newer forms of radiotherapy IMRT.

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A study reported that the use of advanced treatment technologies had increased among men in the Medicare population least likely to benefit from treatment, despite increasing awareness of the extent of over treatment for low risk disease.

Comparative outcomes of surgery and observation for prostate cancer[ edit ] The Scandinavian Prostate Cancer Group Study 4 SPCG-4 cited previously, compared radical prostatectomy to watchful waiting among men mean age 65 years with localized prostate cancer diagnosed in the era prior to PSA screening.

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For these men, no treatment may be the most rational initial management considering that harm quality of life decrement is likely to outweigh any benefit prostate cancer mortality reduction.

Identification of candidates for observation[ edit ] Prostate cancer is in most cases a slowly progressive disease. However, cheloo socola localized disease is curable whereas metastatic disease is not.

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Thus, a continued debate among clinicians is whether to treat early to prevent disseminated disease, or observe and delay treatment until there is evidence of progression. The former risks harm from overtreatment of an indolent disease; whereas the latter risks missing an opportunity for cure among those destined to experience progression.

An unmet need is to identify the relatively small proportion of men with a lethal phenotype in whom death can be prevented by curative intervention, while avoiding treatment of the large pool of indolent disease that can be detected with screening.

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Selection of patients for active surveillance depends upon patient and tumor metrics, as well as a patient's personal preferences. In this respect, tools for estimating life expectancy can be useful in decision making.

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It is therefore essential that the diagnosis reflect an accurate grade. Finally, the preference of a patient for living with cancer or side effects of treatment should be considered in decision making.

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For some, willingness to accept a decline in quality of life to be rid of a cancer that has minimal chance of prosztatarák aktív felügyelete harm over a decade or more may seem reasonable; while others would rather live with a cancer and maintain their quality of life.

An understanding of a patient's personal preferences should play a large part in shared decision making. The National Comprehensive Cancer Center Guidelines recommend active surveillance as the preferred management option for men with very low risk disease and a life expectancy below 20 years, and those with low risk disease and a life expectancy below 10 years; and an option for those with low risk disease and a life expectancy of 10 years or more, or intermediate risk disease and prosztatarák aktív felügyelete life expectancy less than 10 years.

Progression in active surveillance programs has been defined based on PSA kinetics or exceeding a given PSA threshold, increased extent of cancer or higher grade disease on prostate biopsy, change in digital rectal examination, and proceeding to curative intervention.

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Cancer grade is the strongest feature associated with long term freedom from disease in untreated men, and therefore the finding of high grade cancer Gleason score above 6 is the most universally agreed upon trigger for intervention for men on surveillance. However, it a féregtojások székletvizsgálata that most men who are found to have high grade disease on surveillance biopsies, had the high grade disease missed on the diagnostic biopsy and not progression from low to high grade cancer while on surveillance.

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This misclassification of disease at diagnosis may be reduced in the future with improvements in imaging and biopsy tissue assessment that go beyond the Gleason score. The future of active surveillance[ edit ] Improvements in prostate imaging, biomarker discovery, and genetic profiling of prostate cancers will very likely change the approach to management of men diagnosed with localized prostate cancer.

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Currently, active surveillance is underutilized in part because of the dual concerns that a cancer has been misclassified on a prostate biopsy, and the inability to define biologically which cancers have an aggressive phenotype. Thus, there is both over treatment of indolent disease and under treatment of aggressive disease.

Active surveillance of prostate cancer - Wikipedia

In the future it is likely that men with newly diagnosed localized prostate cancer will have had an assessment of the prostate using MRI, targeted biopsies of lesions considered suspicious, and gene expression signatures that focus on profiling the cancer based on molecular pathways associated with aggressiveness.

This multidimensional approach may improve the ability to select the most appropriate candidates for surveillance and our ability to longitudinally monitor specific lesions within the prostate for evidence of disease progression. A number of centers are actively enrolling men in Active Surveillance Programs and have published results on this management strategy for prostate cancer.

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