How to distinguish dangerous from harmless prostate cancer?
In order to avoid unnecessary treatment, it is important to distinguish between significant and insignificant tumors, that is, to determine whether prostate cancer (prostate cancer) is in need of treatment or not.
It is known that in many men during their lifetime in the prostate cancer small herd arise, however, do not evolve to a subject in need of cancer (latent prostate cancer, see the origin and forms of prostate cancer ). Such tumors are also referred to as insignificant because they are the lifetime of the patient not clinically significant (important).
Target of numerous investigations, immediately after the diagnosis "prostate cancer" insignificant (not requiring treatment) tumors sure to distinguish from early stages of aggressive tumors, in order to avoid an unnecessary, burdensome treatment in individual cases.
As insignificant applies a tumor having a volume of less than 0.5 mL (diameter of less than 1cm), and a Gleason score of less than 6 (relative child fabric pattern, see classification of prostate cancer ), which is limited to the prostate and not in the capsule has grown (pT2, sgrowth and spread of prostate cancer ).
This classification is based on histological (tissue) studies and after working up the entire prostate gland, so after radical prostatectomy possible, a treatment that should be avoided yes straight way. Therefore, all efforts aimed at a classification based on characteristics of the patient or the tumor, which can be determined before treatment:
Inevitable patient risk factors are age and genetic (race, "predisposition") and hormonal (partly genetic) conditions. Other risk factors such as influences of environment and nutrition, and in particular the body weight can, however, affect (see causes of prostate cancer ). However, it is not established that a change (eg weight loss) reduces the risk again.
Also, the PSA does not allow reliable statements. Thus includes little or no increased value a significant tumor not. Because in rare cases, prostate cancer is little or no PSA, especially small tumors and those with high Gleason score. As evidence of not requiring treatment tumor a low rise in PSA velocity (PSAV), a long PSA doubling time (PSADT) and PSA density of less than 0.15 (see details on the PSA are PSA test ).
After prostate biopsy is considered to be insignificant peripheral prostate cancer when the capsule is free of tumor, the Gleason score less than 6 and more than one sample is attacked by at least six, and the. Along a length of less than 1mm However, to be very rare these tumors.In addition, the postoperative certain Gleason score is often slightly higher, and the tumor volume (not taken eg large tumor with other stamping or small tumor with a punch just striped; details on core biopsy see biopsy not sure measurable prostate biopsy ).
In particular characteristics of the tumor being researched emphatically: There are already numerous markers identified, mainly in tumors surgically removed, but also those which can be detected in the urine. However, the evidence is not yet succeeded in showing that it is different tumor types with significant and insignificant tumors. Nor is it thus possible on the basis of biopsy predict safely the further behavior of the tumor.
This is exactly what would be the goal in order to advise in an insignificant tumor for controlled watchful waiting (English watchful waiting), can thus only for treatment if the tumor continues to grow. In contrast, refers to the way the active monitoring (engl. active surveillance) that due to a significant tumor actually displayed curative (healing) treatment is delayed under observation in order to postpone a possible therapy-related side effects.
Conclusion
Among the prostate cancer with low Gleason score tumors there is insignificant, which must not be treated. But among them are also tumors that continue to grow aggressively. Unfortunately, there is currently no reliable way to distinguish the two groups, and predict the long-term course of insignificant tumors.
So For now provides simultaneous viewing of patient risk factors, history of PSA levels and biopsy results a sufficient basis for deciding on the best a watchful waiting or immediate treatment. A controlled watchful waiting may come into consideration at low PSA, after a biopsy to be insignificant tumor is located (see above) and a calculated life expectancy of patients less than 10 years. However, it should not be forgotten that the knowledge in a moment perhaps "sleeping", but maybe at some point further growing cancer to bear in themselves, can be a significant burden.
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