Following cancer of the prostate with low risk before starting treatment increasingly common

Men with prostate cancer at low risk slow growth may not live long enough to die of their disease. And since there is no conclusive evidence that the management of cancer at low risk prostate prolongs survival, doctors may recommend cancer surveillance and treatment only when it begins to spread.

This is called active surveillance. It is usually reserved for men with small, slow-growing tumors and normal life expectancy of less than 10 to 15 years after diagnosis. Older men in particular are much more likely to die of heart disease and other causes prostate cancer at low risk. Which fueled concern that low risk cases are dealt with too many men who experience side effects without mounting advantages.

The doctors examined the men on active surveillance in three ways:

     *  periodically measuring the amount of PSA in the blood
     *  tumor growth check with rectal examination
     *  giving repeated biopsies at varying intervals.

Active surveillance takes off 
Although it has a long history, active surveillance has recently expanded its scope from academic cancer centers in the community. Now, a new study shows adoption accelerates. "The trend is real and what is a step in the right direction," said Matthew Cooperberg, associate professor of urology, epidemiology and biostatistics at the University of California, San Francisco Medical Center, and lead author of the study.

Cooperberg and his co-author Peter Carroll, chair of Urology at UCSF, examined data from 10,000 men with cancer of low risk prostate cancer treated at 45 urology practices throughout the United States. From 1990 to 2009, the rate of use of active surveillance in men who averaged 66 years of age at diagnosis was hovering at just under 15%. But between 2010 and 2013, the rates suddenly jumped to over 40%. Active surveillance rate increased from 54% to 76% in the same period of time - a similar trend for men to 75 years or more at diagnosis was observed.

"During the treatment of cancer low-risk prostate is a major problem, and these results suggest that the decline," said Cooperberg.

With studies from Sweden, Australia, Michigan, and elsewhere that show similar increases, active surveillance "seems to be gaining ground as a standard business practice," said Stacy Loeb, a urologist and researcher at the Faculty of the University of New York of Medicine in New York.

The future of prostate cancer surveillance 
The long-term data demonstrating the safety of active surveillance for low-risk disease. For example, a Canadian study published this year showed that only 1.5% of 993 men enrolled in an active surveillance protocol in 1995 had died of prostate cancer two decades later. The men were 69 years old on average at diagnosis. "But the active surveillance is not just for older men," Cooperberg said. "Our data show that can be effective in young men too."

Scientists are also looking for less invasive ways to monitor the progress of the tumor - for example, imaging tests or more precise in the blood and urine markers. These alternative approaches could make a much lighter active surveillance in time.

"Active surveillance is used as a middle-ground option," said Dr. Marc Garnick, Gorman Brothers professor of medicine at Harvard Medical School and Beth Israel Deaconess Medical Center and editor of HarvardProstateKnowledge.org. "For example, men who are not sure to consider the PSA test in the first place and who are concerned about over-treatment if they are diagnosed with prostate cancer can find the option of active surveillance attractive. 

This is especially true being Given the lack of evidence that the management of prostate cancer at an early stage extends life. Fortunately, a day mark to provide a means of predicting whether a given processing task based on the genetic makeup of a tumor man. "
By: Charlie Schmidt