Treatment of prostate cancer:is it always necessary ?

Written by: Dr. Manuel Martínez Sarmiento
Published: | Updated: 08/11/2018
Edited by: Top Doctors®

Although prostate cancer is the most common adult male tumor and the second leading cause of cancer death, only a small proportion of those diagnosed with prostate cancer will die from it.

Prior to PSA (prostate specific antigen analysis), only 30% of tumors were detected at an early stage , ie at a stage where tumors are localized and potentially curable. Since its introduction, these numbers have changed dramatically, and now most tumors are diagnosed when they are located.

However, in return, half of the tumors that are currently diagnosed are tumors with no clinical significance , which would never have been diagnosed if a PSA had not been performed, and because of its slow growth it is very likely that they will never present symptoms let alone provoke death from prostate cancer.

The word "cancer" is a term that generates rejection in patients and their family environment. We are increasingly aware that many tumors have no impact on patient survival , which probably should not have been diagnosed, as they do not require treatment.

The important thing is not to know if you have a tumor or a cancer, but what is the aggressiveness of the tumor , that is, to which risk group they belong (high, moderate, or low risk).

Tumors of moderate or high risk require treatment , sometimes even not one but several. However, low-risk patients may need treatment, never requiring it or delaying it in time, thereby delaying the onset of side effects of treatment, especially the two most important: impotence and incontinence.


What is active surveillance

Active surveillance consists of not immediately treating the patient diagnosed with prostate cancer of very low risk, but subjecting it to close surveillance , which includes recurrent prostate biopsies from time to time, to offer a treatment with curative intent (radical prostatectomy or radiotherapy ) if the tumor is found to progress.



There are a number of clinical parameters (rectal tact), analytical (PSA value) and histological (biopsy characteristics) that allow selection of patients with good prognosis who are candidates, if they wish, to follow an active surveillance protocol. In general, the inclusion criteria are as follows:

  1. PSA at diagnosis less than 10 ng / ml
  2. Tumor not palpable or localized to rectal examination. 
  3. Gleason (system that measures the degree of aggressiveness of a cancer) equal to or less than 6
  4. At most 2 cylinders (tissue samples) with tumor on the biopsy. 
  5. Minor affectation of 50% of the affected cylinders.

However, not all patients meeting these criteria are willing to follow an active surveillance protocol. In fact, the anxiety that generates the patient and his relatives knowing that he has 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 that, therefore, the survival of patients undergoing active surveillance is lower than that of patients undergoing immediate curative treatment.

However, it is known that the survival rates of patients with low or very low risk under active surveillance are similar in comparison to immediate treatment.

Therefore, active surveillance is a suitable therapeutic option that is progressively imposing, since it does not pose a potential risk to patients, avoids complications of treatment in a high percentage of patients who will never need it, and in case of The potential side effects of treatment are delayed over time.


Actions by the patient

It is essential that you follow the clinical controls and recommendations established by your urologist. It is very likely that you do not need treatment for your tumor at any time, but the follow-up will allow to detect if the tumor progresses and if necessary to treat it.

Yes it is highly recommended that you do not gain weight and lose weight in case of obesity, as it has been shown to be a factor that predisposes the tumor to progress. It can help a diet as Mediterranean as possible, with a large consumption of vegetables rich in antioxidants, such as tomatoes, squash, grapes, soybeans, etc. and avoid foods high in fat, especially animal.

*Translated with Google translator. We apologize for any imperfection

By Dr. Manuel Martínez Sarmiento

Degree in Medicine from the University of Valencia, Dr. Manuel Martinez Sarmiento is a doctor specializing in urology. Currently he works as a urologist at the Hospital of Valencia House Health and a member of the unit uro-oncology and laparoscopy University Hospital and Polytechnic La Fe de Valencia.

*Translated with Google translator. We apologize for any imperfection

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