The German Society of Urology (DGU), in view of the discussion about the right treatment of …prostate carcinoma, has pleaded for comprehensive information about the potential risks and chances of active invasive therapy versus a wait-and-see attitude (active surveillance).
Patients at low risk would be informed by urologists about surgery and radiation as well as alternative approaches such as active surveillance.
“The safe trade-off between observation and surgery remains difficult, and extensive and complex counselling and education is necessary,” a statement by the DGU and the German Cancer Society’s Working Group on Urological Oncology (AUO) said. A few weeks ago, DGU President Axel Schroeder had already pointed out in an interview with the German Medical Journal that surgery is not the best therapy option in every case.
An American study has now shown that in the case of prostate carcinomas, radical prostatectomy does not offer any significant advantages in the first decade after surgery compared to a wait-and-see approach. However, this only concerns selected forms of prostate cancer.
In their statement, the DGU and AUO emphasised the importance of PSA screening: “In view of the persistently high mortality of prostate carcinoma as the third most frequent cause of cancer death in men and the overall increase in life expectancy, the fundamental rejection of early detection by means of PSA testing and, if necessary, active, curative therapy in media reporting seems cynical.”
The PSA test is still the most important instrument for the early detection of prostate cancer. And all data from controlled studies showed that it is worthwhile to find potential carcinoma in younger men at an early stage and to treat it aggressively (surgically) if necessary.
Comment from Dr Keul: Since 2007 I have offered my patients the opportunity to participate in the “prias.project” for Active Survaillance. This is a worldwide study for controlled surveillance in prostate carcinoma. Such a procedure must be carried out within the framework of a study for the safety of the patients. In Spain, apart from me, there is only the University of Pamplona participating.