Should localized prostate cancer in the favourable group no longer be treated?

• Published in: Batna Journal of Medical Sciences
• Main Authors: Kamel Hamizi, Souad Aouidane
• Format: Article
• Language: Arabic
• Published: Algerian Society of Clinical & Oncological Pharmacy 2022-01-01
• Subjects: prostate; as; gleason; psa; favorable group
• Online Access: https://batnajms.net/wp-content/uploads/Archives/2021/2/13_BJMS_8_2_Hamizi.pdf

In contrast to abstention-surveillance, active surveillance is a curative management modality. It aims at delaying the treatment of a less aggressive tumor until it becomes aggressive while remaining within the window of curability of the disease. Through a reading of the literature, we will try to shed light on the place and modalities of active surveillance, in the favorable groups of prostate cancers and to answer the following questions: Why active surveillance? For whom? How should it be instituted? And when should it be stopped? The majority of published clinical trials agree that active surveillance is a perfectly suitable approach for patients in the favorable AMICO group, and even for some of the intermediate-low risk group. The results in terms of overall survival and metastatic events are similar to those of patients treated with surgery and or radiotherapy, with less toxicity. Monitoring is based essentially on periodic PSA measurements and rebiopsy according to each team's own protocols. The decision to switch to invasive treatments will be conditioned by the progression of the Gleason score, according to algorithms, some of which are already validated internationally. Active surveillance should be an integral part of the management decisions for favorable localized prostate adenocarcinoma. This attitude allows us to avoid over-treatment of a large number of small, non-progressive lesions, while having the possibility and the means to catch up with lesions that progress.