Although prostate cancer is the most common tumor in the adult male and the second leading cause of cancer death, only a small fraction of those diagnosed with prostate cancer will die from it.
Before the PSA (prostate-specific antigen test) era, only 30% of tumors were detected at an early stage, i.e. at a stage where the tumors are localized and potentially curable. Since its introduction, these figures have changed dramatically, and now most tumors are diagnosed when they are localized.
However, on the other hand, half of the tumors that are diagnosed today are clinically insignificant tumors, which would never have been diagnosed if they had not undergone a PSA test, and which, because they grow so slowly, are very likely never to cause symptoms, much less death from prostate cancer.
The word “cancer” is a term that often generates rejection in patients and their families. We are increasingly aware that many tumors have no impact on the patient’s survival, that they probably should not have been diagnosed, since they do not require treatment.
The important thing is not to know whether one has a tumor or a cancer, but what is the aggressiveness of the tumor, that is to say, to which risk group it belongs (high, moderate or low risk).
Moderate or high risk tumors require treatment, sometimes not just one but several. However, low-risk patients may need treatment, never require treatment, or delay it over time, thus delaying the onset of treatment side effects, especially the two most important: impotence and incontinence.
What is active surveillance?
Active surveillance consists of not immediately treating a patient diagnosed with very low-risk prostate cancer, but subjecting him to close surveillance, including repeated prostate biopsies at regular intervals, in order to offer him treatment with curative intent (radical prostatectomy or radiotherapy) if the tumor is found to be progressing.
Indications
There are a number of clinical (digital rectal examination), analytical (PSA value) and histological (biopsy characteristics) parameters that allow selection of patients with a good prognosis who are candidates, if they wish, to follow an active surveillance protocol. In general, the inclusion criteria are as follows:
- PSA at diagnosis less than 10 ng/ml.
- Non palpable or localized tumor on rectal examination.
- Gleason (system that measures the degree of aggressiveness of a cancer) equal to or less than 6.
- At most 2 cylinders (tissue samples) with tumor in the biopsy.
- Less than 50% of the affected cylinders are affected.
However, not all patients who meet these criteria are willing to follow an active surveillance protocol. In fact, the anxiety generated in patients and their families by the knowledge that they have a tumor that is not being treated is one of the causes of abandonment of active surveillance.
Risks of delaying treatment
One of the theoretical risks of active surveillance is the possibility of tumor spread and, therefore, that the survival of patients under active surveillance will be lower than that of patients undergoing immediate curative treatment.
However, it is known that survival rates of patients with low or very low risk undergoing active surveillance are similar compared to immediate treatment.
Therefore, active surveillance is an appropriate therapeutic option that is progressively being imposed, since it does not pose a potential risk to patients, avoids treatment complications in a high percentage of patients who will never need it, and in case it is needed, the possible side effects of treatment are delayed in time.
Actions on the part of the patient
It is essential that you follow the clinical controls and the recommendations established by your urologist. It is very likely that you will not need treatment for your tumor at any time, but follow-up will allow us to detect if the tumor progresses and if it is necessary to treat it.
It is highly recommended that you do not gain weight and that you lose weight if you are obese, as this has been shown to be a predisposing factor for tumor progression. A diet as Mediterranean as possible can help, with a high consumption of vegetables rich in antioxidants, such as tomatoes, pumpkin, grapes, soybeans, etc. and avoiding foods high in fat, especially those of animal origin.