“active” surveillance is better than therapy- breaking latest news

Prostate cancer is the most frequent cancer among males from the age of 50 of which in Italy there are about 36 thousand new diagnoses every year, but in about 4 out of 10 cases it is non-aggressive carcinomas, with a low risk of progression. , which can only be kept under control and do not require immediate care. In this way, men can continue to carry out their daily activities without having to face the most frequent and most feared undesirable consequences of therapies: erectile dysfunction and urinary incontinence. New evidence in favor of “active surveillance” programs, especially for males over 60, come from the results of two studies presented during the last congress of the European Society of Urology (Eau), one Swedish and the other coordinated by the patient association Europa Uomo. “Mortality has been decreasing since 2000 and is It is essential that the therapies be personalized on the individual patient based on his characteristics and the type of neoplasm, his aggressiveness, the risk of the disease getting worse – underlines Riccardo Valdagni, director of the Prostate Program at the National Cancer Institute (Int) in Milan and associate professor of Radiotherapy at the University of Milan -. It must be clear that not all tumors must necessarily be treated: sometimes aggressive treatments are needed, at others the patient must only be kept under observation and thus avoid unnecessary treatments and possible severe side effects ».

Useful surveillance for over 60s

The first study analyzed the data contained in Sweden’s National Prostate Cancer Register, the Swedish registry that collects information on men from that country who have received a diagnosis of prostate cancer since 1998, 23,649 of whom were performed under active surveillance. . “This option, introduced in clinical practice for almost 20 years, is reserved only for certain types of patients: those with a small and non-aggressive carcinoma – clarifies Valdagni, who is also director of Int Radiotherapy, the Italian center with more experience in this strategy -. He plans to keep the tumor under control, postponing any treatments when the disease changes attitude, if it changes. Thus postponing, for years or for a lifetime, together with the therapies also their possible side effects. Since 2004 we have followed about 1300 patients in the Int and to date none of them, in active surveillance, have died or developed metastases. “Researchers from the University of Gothenburg evaluated both the number of patients in active surveillance and who have died over the years due to the malignancy, both the share of those who have passed from controls alone to treatment (surgery, radiotherapy or brachytherapy) and have concluded that, in particular for patients over 60, monitoring is a winning choice: most of the patients in fact, he lived 10 years or longer without having to undergo therapy and the death rate was very low.

The choice is up to the patients

“Today it is estimated that about 40% of cases diagnosed each year in Italy belong to a category of low or very low risk of progression – remembers Valdagni -. These patients have a high probability that their tumor will remain stationary over time, does not grow, does not metastasize and the life expectancy of these people is getting longer. Faced with a prostate cancer in the low risk class, the optimal therapeutic solutions are different: surgery, radiotherapy, brachytherapy or active surveillance -. With the same efficacy, the choice must be made taking into consideration the possible side effects. It is men who, weighing the pros and cons of each option, must determine what is best for their quality of life. “Another study presented at the Eau 2021 conference analyzed precisely the impact of monitoring on the sex life of patients, starting from what those directly involved reported in specific questionnaires on the quality of life. “The EUPROMS study (Europa Uomo Patient Reported Outcome Study) is the first conducted directly by patients for other patients – explains Bernardo Rocco, president of the Scientific Committee of Europa Uomo Italia, full professor of Urology at the University of Milan and director of the ‘Urology at the San Paolo Hospital -. About 3,000 men in 24 European countries responded to the survey from their home, in order to have the time and comfort to respond comprehensively and calmly: less than 45% of those surveyed on active surveillance reported erection problems, while it rises to 70-90% of males subjected to treatments ».

Visits to the urologist after the age of 50

Fortunately, today over 90% of patients are still alive 10 years after the diagnosis of prostate cancer: an important milestone, achieved thanks to prevention and advances in research and technology. “Where the prevention programs have relaxed, as happened in the United States, there has been an increase in cases diagnosed at a more advanced stage – concludes Rocco -. And the more the intervention is not timely, the worse the results of the treatments will be. In the words of Professor Van Poppel, president of the Scientific Committee of Europauomo, “early diagnosis must take place through a screening strategy adapted to the risk of the individual patient, and this will save other lives”. And the urological visit is precisely the moment in which the right strategy is set, both for prevention and for possible treatment: it is recommended from the age of 50 or even from 45 in case of family. What if prostate cancer is diagnosed? The urologist will always evaluate the possible surveillance or vice versa the need for active treatment of the tumor. Treatment which, to ensure maximum oncological and functional results, must be performed in reference centers that have the medical, technological and organizational resources required for the management of the most frequent male cancer “.