Active surveillance is the recommended approach for low-risk prostate cancer. It can prevent unnecessary treatments and ensures that cancer progression is detected and stopped in good time. Active monitoring is being implemented much faster at Zurich University Hospital than in the rest of the canton. This is shown by a study conducted by the Department of Urology at the USZ.
Prostate cancer occurs in many men at an older age and usually grows slowly. In the case of prostate tumors that are still confined to the prostate, do not cause any symptoms and are considered low-risk, treatment may not be necessary. Instead, the strategy of active surveillance is applied. As part of active monitoring, the patient undergoes regular check-ups, during which the PSA value is monitored and diagnostic imaging (ultrasound, magnetic resonance imaging) and tissue samples from the prostate (control biopsies) are regularly taken.
Systematic monitoring instead of surgery or radiation
Several studies have shown that regular monitoring has no health disadvantage for patients compared to immediate therapy. On the contrary, active monitoring prevents overtreatment. Active treatment such as surgical removal of the prostate or radiotherapy is only carried out at a later stage or proves to be unnecessary in the further course of the disease. In this way, the typical side effects of the treatments can be avoided. Active surveillance has therefore been the procedure recommended by the European Association of Urology/EAU for low-risk prostate cancer since 2009. Since then, it has been offered to patients at the Prostate Cancer Center of the USZ as a treatment option and implemented in accordance with the recommendations.
Not everywhere is actively monitored when it is possible
A team from the Department of Urology at the USZ, together with colleagues from the Cancer Registry of the Canton of Zurich, has scientifically analyzed the data on active surveillance over the last ten years. The question here was how active monitoring has become established in the canton since the official recommendation began in 2009. Data from a total of 3393 patients with low-risk prostate cancer from the ZH Cancer Registry were analyzed.
This showed that from 2009 to 2018, significantly more patients at the USZ chose active monitoring than patients treated in the rest of the canton (55.7% vs. 16%). Correspondingly fewer operations were performed at the USZ (43.9% USZ vs. 71% ZH). The proportion of active monitoring in the treatment options rose over the years at the USZ from 35.4% to 88.2%, in the canton only from 12.2% to 16.2%.