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21 March 2010 New update of active surveillance for prostate cancerIn a long media release recently, the National Comprehensive Cancer Network (NCCN), evaluated the role of active surveillance and other prostate cancer treatment options recommended in the recently updated NCCN Guidelines for Prostate Cancer. In order to tailor prostate cancer therapy to an individual patient several variables that must be considered and the NCCN Guidelines provide a solid framework on which to base these treatment discussions and subsequent decisions. In addition to various controversial aspects of management, other factors such as the complexity of the disease and the lack of sound data to support most recommendations only compounds the challenge of treating prostate cancer. The NCCN Guidelines have established a new “very low risk” category that incorporates the strictest Epstein criteria from all definitions for clinically insignificant prostate cancer. In addition, active surveillance and only active surveillance is now the recommendation for many men diagnosed with prostate cancer. Men with low risk prostate cancer who have a life expectancy of less than 10 years and men with very low risk prostate cancer with a life expectancy of less than 20 years should be offered and recommended active surveillance. The active surveillance program recommended is defined in the NCCN Guidelines and stresses that active surveillance involves actively monitoring the course of the disease with the expectation to intervene if the cancer progresses. Patients under active surveillance must commit to a regular schedule of follow-up, which includes a prostate exam and PSA and may include repeat prostate needle biopsies. Accurate life expectancy and time to death estimates are critical to guiding informed decision making in the treatment of prostate cancer. The Social Security Administration tables should be used to calculate life expectancy, and adjusting for overall health status and then comparing this to the estimated time to death from prostate cancer. To calculate time to death from prostate cancer needs to evaluate the patient’s Gleason score, tumor volume, and tumor aggressiveness and that estimate needs to be compared carefully to a man’s physiological age, not his chronological age. NOTE: Issues on this site regarding prostate cancer and treatment options, are provided for information only, and are not meant to substitute for the advice of your own physician or other medical professional. Prostate-Report.org does not endorse any specific product, service or treatment. |
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