Active Surveillance for Prostate Cancer Could Be Better Option

gaitonde & patientCINCINNATI—It’s often a medical dilemma: treat or don’t treat (meaning watch the condition closely and treat at the most opportune time).

A study published this spring in the New England Journal of Medicine suggested that young men who undergo early prostate cancer surgery have a better chance of survival than those who choose a watchful waiting strategy.

The randomized study conducted over 23 years by researchers from Sweden and the Harvard School of Public Health looked at 695 prostate cancer patients and divided them into two groups: watchful waiting and surgery. They found that men under the age of 65 who underwent surgery to remove their prostate gland were less likely to die from the disease than those who were not treated unless their cancer progressed. However, men over the age of 65 who underwent surgery did not decrease their risk of death, but did see a small reduction in the risk of the cancer spreading to other organs.

Krishnanath Gaitonde, MD, a member of the UC Cancer Institute, associate professor in the division of urology and a UC Health urologist, says this does not necessarily apply to all prostate cancer patients.

In light of National Men’s Health Awareness Month observed in June, he says that current prostate cancer surveillance guidelines—using specialized techniques exclusively offered at UC Health for Tristate patients—provide more targeted mapping of the disease which can instead help physicians decide the best next steps as opposed to jumping to invasive surgery.

“Prostate cancer is the second most common cancer in American men; about one in six will be diagnosed with prostate cancer during his lifetime,” Gaitonde says. “There is a 30 percent risk of underestimating the extent of the disease or a possibility of treating it too early. The guidelines used to defer surgery in the NEJM study were different from the current standards used today; therefore, results of the study cannot be generalized to our current patient population.

“The multi-parametric magnetic resonance imaging (mp-MRI) scans, offered at UC Health, can help make this distinction and serve as a guidance tool for prostate biopsies which in turn can help us obtain better risk profiling of the disease.”

He says functional magnetic resonance imaging, such as MR diffusion and MR perfusion—which specifically image cancer cell “crowding” and maps of blood flow, which increase in cancer cells—assist with detection and help physicians decide how to proceed. These techniques can also be used to closely monitor patients who decide to defer surgery.

“Traditional prostate biopsy involves ‘blind,’ or non-targeted, sampling of the prostate. Using this technology, when a biopsy is needed, the suspicious findings on the mp-MRI can be targeted for MRI-ultrasound fusion targeted biopsy, using the Artemis Navigation System, or direct MRI-guided biopsy,” he says. “The fusion-targeted biopsy involves coupling of MRI and ultrasound to visualize suspicious lesions in the prostate gland.

“With this technology, which is only used locally by UC Cancer Institute experts including urologists James Donovan, MD, and Nilesh Patil, MD, and radiologist Sadhna Verma, MD, we can more efficiently and effectively biopsy the potentially cancerous prostate and decide if surgery is truly necessary.”

However, Gaitonde says the first step before biopsy or surgery is being aware of your risks.

“It’s important to first be aware of a family history of this cancer,” he says. “If there is a clinical concern for prostate cancer that requires a biopsy or if you have had a previous negative biopsy, please consider this option. Additionally, if you have prostate cancer diagnosis, this technique can help in making an informed decision about how to proceed with treatment.”

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