Patients with low-risk (early-stage) prostate cancer expectations

Low-risk prostate cancer (usually defined by a T1c-T2a clinical stage, a PSA < 10 ng/ml and a Gleason score of ≤ 6) is the most common stage in patients in whom prostate cancer has just been diagnosed. It is currently treated by active surveillance, by prostatectomy or by radiotherapy. One of the main difficulties in the treatment of the disease is to prevent progression toward a later stage (which is accompanied by a higher risk of metastases and of mortality) while preserving patients’ quality of life (particularly urinary and erectile functions).

Sourcing: Recommandations en onco-urologie 2016-2018
http://www.urofrance.org/sites/default/files/afuimport/v27sS1/S1166708716307059/main.pdf

1) Prevent the typical side effects of radical treatments on urinary and erectile functions.

2) Do not wait to be treated.

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When a man is diagnosed with prostate cancer and is assessed as being “low-risk” or “early-stage”, he initially becomes very anxious.

The patient searches then for information and advice, not only from his urologist but also from relatives who have gone through the same experience, and informs himself about the disease. Some patients immediately confide in their partner and their family, others do not.

Several options are available to the patient:
• Radical therapy option (destruction or removal of the prostate)
• Active surveillance (therapeutic abstention) option: the patient must undergo surveillance, without treatment, for a certain amount of time (possibly for several years) and have regular medical examination such as PSA test, clinical examination, biopsies, MRI scans, etc. In the case of progression of his cancer and if the urologist believes that abstention is no longer possible, the patient will finally receive treatment.
• Focal therapies, recent option, aims to destroy low-risk prostate cancer in a targeted manner.

Professor Jonathan Coleman, urologic surgeon at MKSCC, New-York, USA