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Local Treatments with Radical Aims for Prostate Cancer Therapy: an Overview
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Abstract
The treatment of prostate cancer proposes different goals, depending on the anatomical extension and aggressiveness of the disease, but also on the patient's life expectancy and on the presence of comorbidities that may represent a risk of death greater than that represented by the same prostatic neoplasm. It should not be neglected, in fact, that a small portion (about 40%) of patients diagnosed with prostate cancer is destined to die "with" and not "for" their cancer and that this percentage also includes patients with locally advanced or metastatic disease. For this reason, in patients with short life expectancy (generally less than 10 years), due to advanced age or the presence of comorbidity with higher lethality than prostate cancer itself, it may be indicated a watchful waiting policy. Similarly, patients suffering from a very low-low disease, even in the presence of a good life expectancy, can be directed towards an active surveillance policy. The watchful waiting policy is a policy of surveillance (in the absence, however, of systematic checks) of those patients in whom it is considered reasonable to think that the immediate treatment of the tumor is not able to impact on their life expectancy and in which, therefore, any therapies can be delayed with the appearance of symptoms, with almost exclusively palliative purposes. Active surveillance is instead a strategy of possible deferred treatment, which is offered to patients with low-disease very low risk to the diagnosis to which, instead of an immediate treatment, the option of a close monitoring is offered, through the periodic repetition of prostate biopsies, of the clinical examination, of the PSA (and in some specific cases of multiparametric MRI) in order to promptly detect any disease progression, and only then start the patient with local treatment with "radical" intent.
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