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Urology 2019

Making informed decisions for prostate cancer

Paul Villanti

Executive Director, Movember Foundation (pictured above)

Thousands of British men are now choosing to have their prostate cancer monitored instead of having surgery or radiotherapy. It is an important decision that must be carefully considered. Active surveillance vs treatment: which is best?

Every year, around 47,000 British men will find out they have prostate cancer. Those with an aggressive form of the disease will need rapid treatment in the form of surgery, radiotherapy or sometimes chemotherapy.

However, if it is classed as being ‘low risk’ or slow-growing and looks likely to stay that way for some time, then it is often possible to have no treatment at all – an approach known as active surveillance (AS).

For a man who just been told that he has a type of cancer that kills 11,000 men every year, the idea of having no active treatment for it, can be a difficult one to get his head around.

Sometimes, doing ‘nothing’ is the safest option.

Active surveillance is an alternative to active treatment, which involves regularly monitoring low-risk or slow-growing prostate cancer instead of undergoing radical treatment such as surgery or radiotherapy.

It allows some men to avoid, or delay, the start of treatments that can carry side effects such as incontinence, sexual and bowel dysfunction – all of which can have a long-term impact on their quality of life. 

Researching the potential for active surveillance

Up until relatively recently, it was thought there wasn’t enough evidence for doctors to recommend it.

That’s why the Movember Foundation invested in researching active surveillance through the GAP3 project. The aim is to create the world’s largest centralised database of men with prostate cancer on active surveillance. It includes clinical, MRI and genomics data from over 15,100 men in 12 countries who have chosen active surveillance.

It will allow clinicians to better identify men who are suitable for active surveillance and more accurately determine when a man’s cancer has progressed to the point that he needs active treatment.

Data suggest more UK men are opting out of surgery

There are signs that the trend towards AS in the UK is rising. Earlier this year, the National Prostate Cancer Audit Annual Report showed that the proportion of low-risk men who opted for radical treatment in 2016-17 fell from 8% to 4% in one year.

This is good news because the problem of men being overtreated has been one of the challenges we face in treating prostate cancer. 

But just because it’s the right path for some men – that doesn’t make it an easy decision. Choosing whether to have treatment or not can be very tough. It’s vital that men get the information they need and understand the risks involved so that they can make an informed decision about their own treatment and no man is left regretting that choice later down the line.

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