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Home » EU Health, Health, Prostate Cancer

Future challenges for better control of prostate cancer

Submitted by on 14 Jul 2017 – 10:00

Reducing over-diagnosis and the resulting overtreatment through refined and improved early detection is crucial in improving the quality of life and survival of prostate cancer patients. Dr Tit Albreht, Head of Centre, National Institute of Public Health raises a few key challenges

There are several important points to be raised concerning prostate cancer management and control for the future. The first one is related to refining the possibilities and the means of early detection. Prostate Specific Antigen (PSA) does not prove to be an adequate and efficient tool for population-based screening and its controversies continue raising many concerns.

More importantly, it is becoming increasingly important to better identify the subpopulation of men at high risk for the development of invasive disease. Methods to move in this direction have already been improved but too many patients still remain immersed in the masses of PSA-positive cases, which require additional diagnostic workup.

Moreover, further work should be undertaken to assess the combination of different methods, especially including the new technological opportunities of the multi-parametric MRI. Obviously, these exert additional financial challenges where objectives and cost-benefits of raising such complex and technologically intense options need to be assessed very precisely.

National Institute of Public Health as a public health institute, dealing with health promotion, screening and early detection of non-communicable diseases (NCDs), will be available to work on fine tuning all screening and early detection methods that could help in reducing the burden of NCDs, in particular, the burden of cancer. As cancer has already become the number one group of causes of death in men in most highly developed countries, it is clear that we need to address this challenge in a clear and resolute action.

Secondly, it is important to further explore and research the area of ‘watchful waiting’, which through delaying the initial treatment clarifies an important number of cases as not invasive or not as invasive as to require an immediate treatment. This might be beneficial both for patients (who will be thus less exposed to side effects of treatment) as well as for health professionals as the workload of new cases would be gradually reduced without any harm in performance.

Another aspect in this sense is the consideration of patient’s age at the initiation of aggressive treatment. This needs to be assessed in view of the comorbidities these patients may have (especially taking into account their age).

Thirdly, it is important to work on all aspects of after-care and survivorship issues. Given the advances in treatment, survival in prostate cancer has improved greatly, which means that there are increasing numbers of patients who require follow-up. This further raises the importance of putting more stress on the quality of life, both of patients as well as that of survivors. Because of the implications of side effects of treatment, patients and survivors need to receive an adequate level of psycho-oncological care available to them in a prolonged period of time and not only during active treatment.

Other important aspects of survivorship such as rehabilitation and full return to pre-morbid life are of essence to cancer survivors, not the least to prostate cancer survivors.