prostate cancerNew information regarding prostate cancer treatment continues to be made available and large multi-year studies are data-mined to answer new questions. What are the most predictive parameters to help decide if prostate cancer should be treated aggressively or observed?  Over a 10 year period after diagnosis, does the population of observed patients have a higher rate of death than treated patients?  Apparently not.  Does the population of observed patients have a higher rate of metastatic disease (and associated morbidity) than treated patients?  Apparently yes, and metastatic disease is found at DOUBLE the rate in observed (active surveillance) patients than treated patients.  At intervals longer than 10 years, it is certainly possible and probably likely that the mortality rate would also be higher in the active surveillance patients.  The results are fascinating.

What Other Indicators Are There?

In addition to PSA and Gleason score, the total amount of cancer found in a biopsy appears to be very significant as to prognosis, and this type of finding points to the potential advantage of TPMB…transperineal mapping biopsy as opposed to the more traditional 12 course transrectal biopsy.  This certainly also points to the importance of long-term and very detailed and careful monitoring of observed, or active surveillance patients.  This is especially crucial in patients with a 10 year or more life expectancy.  In addition, for patients observed and relatively stable without treatment for several years, complacency may be difficult to avoid from the patient OR the physician in some cases, but continued careful monitoring should be done.

Has Prostate Cancer Treatment Changed?

Prostate cancer treatment was basically the same for decades, but over the last 5 years it appears, almost everything is changing!  Please stay tuned as I continue to update information here and in how elevated PSA and prostate cancer diagnosis and treatment are approached in my Las Vegas Urologist office.