Not every prostate cancer needs to be treated

Last updated on November 17, 2023 First published on November 16, 2023

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%.

Active surveillance is offered more frequently at the certified prostate cancer center

The study team also used the data to investigate the question of why active monitoring has not yet become established across the board in the canton of Zurich, despite its benefits for patients and the low treatment costs. One reason could be that, according to studies, recommendations are generally accepted more readily in university clinics than in other treatment centers. In certified cancer centers such as the Prostate Cancer Center of the USZ, strict adherence to the guidelines is a given. The most important difference, however, is that every case at the Prostate Cancer Center is discussed by an interdisciplinary tumor board of cancer treatment specialists. The tumor board recommends the most effective and gentle therapy for each patient from the entire range of therapies available. “For patients who meet all the criteria for low-risk cancer, this is active surveillance,” says Daniel Eberli, Director of the Department of Urology at the USZ. “This strategy is therefore part of the standard range of treatment options at our center.”

Innovative gene expression test provides certainty in therapy decisions

From December 2023, the USZ will offer the Prolaris® test as a supporting test for therapy decisions. This new gene expression test, which is carried out on removed tumor tissue, measures the activity of certain genes that influence tumor growth. This allows even more detailed conclusions to be drawn about tumor aggressiveness. This test is particularly helpful in deciding on treatment for less aggressive tumors. For patients, this test can provide more certainty in the decision as to whether the cancer should be actively monitored for the time being or treated immediately.

Daniel Eberli hopes that active monitoring will gain momentum throughout the canton over the next few years so that more patients can benefit from the advantages of this form of treatment. He recommends that affected men who are not offered active surveillance for low-risk prostate cancer seek a second opinion before deciding on treatment.

Responsible specialist

Daniel Eberli, Prof. Dr. Dr. med.

Director of Department, Department of Urology

Tel. +41 44 255 54 01
Specialties: Prostate cancer: 3D prostate biopsies (MRI fusion, stereotactic), DaVinci robotics and laparoscopy, HIFU (High Intensity Focused Ultrasound), Robotic surgery (kidney and bladder), Treatment of benign prostate enlargement