Men with slow-growing prostate tumors that likely won't be harmful during their lifetime can often avoid immediate treatment. Instead, they’ll monitor their tumors through a technique called energetic surveillance. With this approach, doctors periodically check for tumor growth and start treatment provided that the cancer begins to metastasize, or spread. Active surveillance has develop into popular worldwide, but doctors still debate which groups of men can safely use this strategy. Some doctors offer it only to men who’ve the bottom risk of developing cancer. Others say that men with intermediate-risk prostate cancer can also be good candidates.
Oh A new study It now appears that intermediate-risk tumors usually tend to metastasize on energetic surveillance than initially expected. “Most men do well on surveillance, but we found a higher risk of metastases in intermediate-risk patients over the long term,” said Dr. Lawrence Klotz, director of the University of Toronto's energetic surveillance program. Sunnybrook Health Sciences Centerwhere the study was based.
A have a look at intermediate risk prostate cancer
Sunnybrook's energetic surveillance program dates back to 1995, so it allows for remarkably long-term follow-up. About 1,000 men have joined this system thus far. The majority have low-risk prostate cancer, meaning their prostate-specific antigen (PSA) level isn’t any higher than 10 nanograms per milliliter (ng/mL) and their Gleason rating isn’t any higher than 6. (Gleason scores indicate how aggressive a tumor sample looks under a microscope. In general, intermediate-risk cancers are determined by a Gleason rating of seven or a PSA level greater than 10 ng/mL. However, these intermediate cancers Cancer will also be divided into low- and high-risk categories, depending largely on how advanced the cancer is shown within the biopsy.
The latest evaluation showed that 30 of the 980 men examined within the study eventually developed metastases (or areas of spread). Of these men, two had low-risk prostate cancer, while the opposite 28 were either initially diagnosed with intermediate-risk tumors, or upgraded to that category while on energetic surveillance. The risk of metastasis was 3% overall for all men evaluated, but nearly 4 times that for intermediate-risk men particularly. The median time to metastasis was 8.9 years, meaning that for all men whose cancer spread, half experienced it inside 8.9 years of diagnosis and half experienced it later.
According to Dr. Klotz, the likelihood of metastasis depended mainly on the quantity of Gleason 7 cancer had within the prostate, and whether a person's PSA level doubled rapidly. He expects that some more men within the study will develop metastatic cancer with age and long-term follow-up.
Is energetic surveillance appropriate for some intermediate-risk men?
Although metastasis is a serious problem when it occurs, Dr. Klotz emphasizes that about 80 percent of the intermediate-risk men within the study have thus far avoided this final result. And these people, he said, are also avoiding cancer treatments that will otherwise significantly affect their quality of life. Still, Dr. Klotz urges caution when selecting intermediate-risk men for energetic surveillance. “Based on these findings, I would strongly encourage further evaluation of these men with magnetic resonance imaging and/or genetic biomarkers,” he said.