For patients with slow-growing tumors and in older patients with more serious health conditions, UCLA offers the option of Active Surveillance for cancer of the prostate.
A new study based on the largest-ever clinical trial comparing prostate cancer surgery with a strategy known as “watchful waiting” shows that surgery can be safely avoided for some men with early stage prostate cancer. The study went on to show that many patients would do just as well under observation or a watchful waiting policy. Each year, more than 100,000 radical prostatectomy surgeries are performed in the United States and about 242,000 men will receive a diagnosis of prostate cancer. The study, published in the New England Journal of Medicine, was conducted by the Department of Veterans Affairs over a 15-year period and included 731 men. UCLA’s Dr. William J. Aronson, clinical professor of urology and chief of urologic oncology at the West Los Angeles Veterans Affairs Medical Center, was one of the study authors.
Active Surveillance may be the right course for many patients with prostate cancer (PDF) >
Active Surveillance is a structured program of monitoring for men who, because they are deemed at little cancer risk, choose to defer surgery or radiation therapy, hopefully for the duration of their lives. Some men in Active Surveillance do show cancer progression, become at higher risk, and move on to active treatment. Watchful Waiting is a less intensive type of follow-up that means fewer tests relying on changing symptoms. If intervention becomes necessary, the results of deferred treatment appear to be the same as if immediate treatment had been elected. The key is accurate prostate biopsy.
In men with suspected prostate cancer, prostate biopsy is the standard recommended diagnostic procedure. A prostate biopsy (or a biopsy of the prostate) is a procedure in which small samples are removed from a man's prostate gland to be tested for the presence of cancer. After the biopsy sample has been taken, the prostate tissue is examined by a pathologist to see how far the prostate tissue is from normal. The pathologist will then assign a Gleason score using the Gleason Grading System.
UCLA Medical Center has been on the forefront a new technology that may provide a vastly improved prostate biopsy. The prostate-imaging technology that fuses MRI with real-time, three-dimensional ultrasound appears to offer a more exacting method to obtain biopsy specimens from suspicious areas within the organ. The targeted prostate biopsy program has advanced the science of performing prostate biopsies, which until now, have not changed since the mid-1980s.
Four UCLA departments — urology, radiology, pathology and biomedical engineering — collaborated with the medical device company Eigen Inc. to develop and test the technology. The team's early experiences with it are reported in the online May–June issue of Urologic Oncology 2011. The technology may be most beneficial for patients who fall into one of two categories: those who had prior negative biopsies but have persistently elevated prostate-specific antigen (PSA) levels, and "active surveillance" patients — those with low-risk prostate cancers who are being carefully monitored over time to see if their cancer progresses or becomes more aggressive.
The UCLA team found that targeted biopsy was about five times more likely to find cancer than non-targeted, systematic biopsy. Re-biopsy of a suspicious site was found to be accurate within a few millimeters. "These early results are promising, but more study needs to be completed before we can conclusively show the benefit of tracking and targeting biopsy with this new method," said Dr. Leonard Marks, professor of urology at the University of California, Los Angeles.