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With the introduction of PSA tests, prostate cancer is now routinely diagnosed at early stages. Prostate cancer tends to develop very slowly and may not require surgery for many years. Active surveillance is now favoured by clinicians.

Prostate cancer is the second most common type of malignancies in men, after lung cancer only. 18% of men (one out of six) will be diagnosed with prostate cancer during his lifetime. Advanced prostate cancer is a life threatening condition which required serious medical intervention. This usually involves surgical removal of prostate gland, as well as multiple rounds of chemotherapy and radiotherapy. When prostate cancer is found at early stage, the treatment options are not so certain, however.

Mortality from prostate cancer is gradually declining

Statistics for prostate cancer is improving in recent years. Mortality is slowly but surely falling. This reflects several important achievements in the early diagnostics, treatment and management of this condition. Drugs are improving, surgical procedures are getting better. Most importantly, early detection of disease is now a norm rather than exception.

The number of patients diagnosed with prostate cancer grew dramatically in recent years when general routine screening for prostate cancer for men after 40 was introduced in many countries. The commonly used screening test detects the level of Prostate Specific Antigen (PSA) in the blood. PSA is a protein usually produced by the prostate cancer cells, although it can be also excreted by normal cells of prostate gland and its level can be elevated when some other prostate problems such as prostatitis are present. The level of PSA below 4 ng/ml is considered safe and normal. Further, more probing, investigation is needed when this level is exceeded. This usually includes the biopsy of prostate. Biopsy not necessarily confirms the presence of tumor since it may contain the sample of tissue from unaffected part of the gland.

Introduction of PSA blood tests helped to diagnose cancer earlier and led to significant reduction in mortality from this disease (by 25-40%). However, routine PSA testing also created a problem of over-treatment.

What are your options if you are diagnosed with an early stage prostate cancer?

If the presence of tumor is confirmed, should it be removed straight away? The answer to this question used to be “surely, yes” but now it sounds more like “maybe” or even “maybe not”. The article published in Current treatment options in oncology highlights the problem of the prostate cancer over-treatment. Despite high rate of diagnosis (18% of adult men), only 3% of patients actually die as a result of this disease. This means that 15% of patients diagnosed with prostate cancer die from something else while having cancer, and cancer doesn’t play any role it this. Prostate cancer tends to develop very slowly, often over the period of two or three decades.

Many patients, especially older men, have no chance to experience any problems caused by this disease during their lifetime. On the other hand, complications and discomfort caused by aggressive surgery and treatment can be rather significant and may last for the rest of patient’s life. This is especially important in elderly patients.
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