ISSUE
42
June 2010
Active Surveillance for Low Risk Prostate Cancer BY Dr Jeremy Grummet Prostate cancer can be aggressive and lethal, or slow and non-threatening, or anything in between. The challenge for each man with prostate cancer is working out where along this spectrum their particular disease lies. To guide us, we can use the PSA level and how fast it is rising (PSA velocity), how the prostate feels on rectal examination (the clinical stage), and the Gleason score of the cancer on biopsy (how aggressive or otherwise the tissue looks under the microscope). Putting all this information together, we try to predict the natural course of the disease. If the cancer appears to be localised to the prostate and the patient’s life expectancy is greater than 10 years, he and his specialist together decide
whether radical treatment will be undertaken with the aim of curing the disease. The question is, does the cancer need to be cured? The mainstream treatments for localised cancer are surgery (radical prostatectomy), which can be performed using several techniques, and radiotherapy, which may also take different forms. Whichever treatment is chosen, by virtue of the prostate’s delicate anatomical position, there are potential side-effects involving urinary, sexual and bowel function which may have a serious impact on that man’s quality of life. Since the introduction of PSA testing, we are finding many more prostate cancers with low risk features. In other words, these cancers may never progress or cause the patient any harm. So should these men be subjected to treatment which may not be necessary, and which may even cause harm? CONTINUED PAGE 3