First seen and treat only when tumor progression curative (healing), under specified conditions is an option for localized prostate cancer because these often grows very slowly.
Active surveillance (engl. active surveillance, AS) means a principle possible (eg because of another disease or only temporarily impossible) curative (healing) under close monitoring to defer treatment until the tumor progresses or the patient desires therapy. Contrast is meant by expectant monitoring (engl. watchful waiting, WW), long term observe the patient and initiate a palliative (palliative) treatment once the tumor symptoms (symptoms) caused (see Expectant observation in prostate cancer ). Both are also known as delayed treatment (engl. deferred treatment) or conservative procedure summarized, which expresses that one monitors the patients and only in the progression of the tumor on the further treatment decisions.
The aim of active surveillance is an "over-treatment", so to avoid unnecessary treatment to the individual concerned is engaging therapy and their possible side effects for the time being, or - to spare even permanently - if the tumor does not progress. Such a strategy offers just for prostate cancer in which was discovered at an early stage because it often grows very slowly, especially when it occurs in old age (see also the growth and spread ). So it may take many years to occur until tumor-related symptoms, and perhaps the person is previously died of a cause other than the tumor.
Some tumors, however, continued rapid stride, with a prediction of dangerousness on the basis of tumor characteristics is not easy. The criteria by which one can decide with sufficient certainty whether any immediate action is needed, or you can wait were previously in dispute.Here the German S3 guideline of 2009 (see also has New prostate cancer guidelines ) finally brought clarity. For all studies were systematically collected on this subject and evaluated and derived recommendations for starting, control and completion of an active surveillance:
Start of active monitoring
Conditions for the onset of active surveillance to be:
- PSA level to 10 ng / ml
- Gleason score to 6
- T stage T1c (tumor by needle biopsy found) and T2a (tumor in more than half a prostate page)
- Tumor involvement of more than 2 samples of prostate biopsy
- Tumor invasion by more than 50% of a sample
Active surveillance should therefore be performed only in younger, otherwise largely healthy men with localized prostate cancer, which has a low risk for future progression.
In the stages T1a and T1b you should note that: you mean that the tumor was accidentally found in tissue removed. This usually originates from a surgery in benign prostatic syndrome (see surgical procedure for BPH treatment ), not from the peripheral zone of the prostate where most prostate cancers arise (see genesis and forms ). There still remains the tumor can thus be located or later develop new tumors. Therefore, a follow-up is recommended with PSA testing and biopsy if necessary before deciding for active surveillance.
Controls with active monitoring
To identify a potential tumor progression in time, to regular check-ups are carried out, with
- Breast exam ( DRE ) and PSA testing in the first two years, every 3 months, then with a stable PSA level every 6 months
- Rebiopsie (repeat biopsy) every 12-18 months
Cessation of active surveillance
Active surveillance is to be completed when
- the Gleason score in the Rebiopsie to more than 6 increases
- PSA doubling time ( PSA-DT ) drops to less than 3 years
Results and Forecast
The above criteria are particularly strict and should therefore ensure a high level of security: include only tumors with a low risk of progression and see short follow-up intervals and a premature termination due to deterioration before.
With active surveillance, numerous stakeholders have until much later (only about 1/3 within 7 years) or not treated. Nevertheless, should not be worse than after immediate curative treatment, the entire tumor-specific (tumor-related) and the recurrence-free (relapse-free) survival rate after active surveillance and possible curative treatment.
Counter-arguments and summary
Against the active surveillance speaks principle that one might miss the right time to intervene, that the costs associated with each therapy risks increase with age, that treatment at a later time might no longer possible (eg due to another disease) and that the progression of the tumor remains even with thorough checks unnoticed in very rare cases, so that a cure is unlikely. Not to mention the psychological burden of the knowledge of living with an untreated cancer.
However, these risks of active surveillance are given proper application of the criteria is very low, especially with careful monitoring. You need to be weighed against the advantage, namely that the person can save an engaging therapy and their possible side effects for many years or even forever.
Ultimately, however, the decision depends not only upon the results obtained, but also the wishes of the person concerned, and numerous other factors. It can therefore only be taken individually after being informed of all treatment options.
Post a Comment