Active Surveillance of Prostate Cancer
Professor Mark Frydenberg AM, talks about active surveillance for prostate cancer and its preference to radiation or surgery for low-grade prostate cancer. https://youtu.be/FqbRGeKbTOQ Video Transcript I’m Mark Frydenberg, one of the urologists at Australian Urology Associates, and I wanted to talk to you today briefly about active surveillance for prostate cancer. In some of our other videos in our series we would have discussed PSA based screening, what PSA is and also the Gleason grading of prostate cancer. [Follow our YouTube Channel] As you would have heard in those videos, if you’re diagnosed with a relatively small low-grade prostate cancer namely a Gleason-6 tumour or Gleason-grade group one tumour, often the likelihood of that cancer growing and spreading is actually very low. Its growth rate is likely to be measured in years, sometimes decades, and in many cases the cancer may not ever cause death of the patient. As such, rushing in to do treatments, such as radiation or surgery, that do carry some potential side effects may in fact be unnecessary and close surveillance is indicated. Now, this is an active process; this isn’t a set and forget where we just tap you on the back and say everything is fine, you do need to be monitored very carefully. This would mean having your PSA blood test done approximately three-monthly. At the end of the first year, you would need to have a repeat MRI scan, and you may in fact be advised even to have a repeat biopsy to be absolutely certain that the cancer was not progressing or growing or becoming more aggressive. Once confirmed at the one-year mark that the cancer was not becoming any more aggressive or larger, then it’s generally safer to continue on surveillance for longer periods of time, and although you’ll continue to do the blood test every three months, it is more likely that there will be greater intervals in between the MRIs and potentially repeat biopsies; and as long as your PSA remains stable, and your examinations are also normal, we can be confident that you would only need to have an MRI perhaps every three years to make sure that the cancer was not progressing. All of the urologists here at Australian Urology Associates have many patients that have successfully been on surveillance for sometimes 15, 20 years and greater, so it’s important to be very comfortable and reassured that this is a very safe way of dealing with low-risk prostate cancer. In fact, most published series have shown that the death rate of prostate cancer after 10 years on active surveillance is only in the order of one percent. As such, this is very safe, as long as you’re compliant and follow your urologist’s instructions to make sure that you do, do your blood test regularly and to follow using their instructions with regards to having repeat MRI scans and biopsies when it’s indicated. Thanks very much for your attention.
Prostate Cancer Gleason Score
Professor Mark Frydenberg AM discusses the Gleason score for prostate cancer grading and what a Gleason Score of 6, 7 and 8 signifies in terms of prostate cancer and its treatment.https://youtu.be/FuwkyvdCCo4 Video Transcript I’m Mark Frydenberg, one of the urologists at Australian Urology Associates, and I wanted to discuss with you Gleason grading of prostate cancer. Once a patient has been thought to have a level of suspicion of prostate cancer and has undergone a prostatic biopsy, the pathologist will have a look down the microscope at the tissues that he’s examining and will describe a Gleason score or Gleason grade if a cancer is detected. What this signifies is the level of aggression of the underlying malignancy, which often plays a very big role in the decision-making regarding the treatments. With a Gleason score, the three common scores are a six, a seven or an eight. If you have a Gleason score of six, it’s considered an extremely low aggression cancer and in many of these circumstances no treatment will be recommended, but close surveillance will be recommended instead. A Gleason 7 tumour is considered intermediate risk and a Gleason 8 or above is considered a high-risk prostate cancer which is aggressive. With the Gleason 7 tumours what they try and do is give us some idea about whether that seven is closer to a six, or whether it’s closer to an eight, and that is why we see the description, a Gleason three plus four equals seven which is the one that’s closer to a six, or four plus three equals seven, which is closer to an eight. Again, a three plus four equals seven will still often require treatment, but in some cases may be suitable for surveillance, whilst it would be very unlikely for a Gleason four plus three or seven or above, to be offered surveillance and in those circumstances active treatment is likely due to the risk of the cancer spreading and potentially causing harm to you in the future.
Should men be screened for Prostate Cancer with a PSA Test
Professor Mark Frydenberg AM discusses the suitability of PSA-based screening for men in the detection of prostate cancer. Video Transcript I’m Mark Frydenberg, one of the urologists at Australian Urology Associates, and I wanted to discuss with you PSA-based screening for prostate cancer. In another video in our series, I’ve described what the PSA protein is and some of the possible causes of why a PSA may be elevated. It’s become a very controversial topic over the last 20 to 30 years as to whether PSA-based testing, namely, having a blood test done every one or two years, is a worthwhile thing to assist in the early detection of prostate cancer and to potentially reduce the likelihood of dying of prostate cancer. It is important to note, that the current National Health and Medical Research Council guidelines do, in fact, recommend prostate cancer testing from age 50 every two years, or earlier if you’ve got a family history. The reason for this is that there’s a very large European study that quite definitely shows around a 20 to 30 percent decreased risk of death from prostate cancer with PSA-based testing. This is very important, however it’s equally important to identify that this is not equal across all men of all ages. If we have a man that is unlikely to survive seven to ten years, in fact there is very little benefit for PSA-based testing, but for all other men, irrespective of age, if they do have an extended life expectancy, then PSA based testing is worthwhile to discuss with your general practitioner or with your urologist. Learn more about prostate cancer.
