Early stages of prostate cancer are best left for watchful waiting. As cancer can take years and even decades to develop, “cutting the patient open” right away might not be the preferable solution. It may be better to postpone surgery until such a time as direct indications for surgical intervention are clearly seen. This approach is gaining more and more traction in the world, and Russian urologists have joined forces with their foreign colleagues in an attempt to create the “ideal” protocol.
Sechenov University has launched a multi-center clinical trial which is going to help create a strategy for active surveillance for patients with low-risk prostate cancer. Aiding in this pioneer national work are the M. F. Vladimirsky Moscow Regional Research Clinical Institute and Pirogov University.
“Our research is registered in the Clinical Trials protocol registration system and is thus acknowledged internationally which greatly boosts our chances of being published in leading journals”, said Dmitry Enikeev, Deputy Director for Research at the Institute for Urology and Reproductive Health of Sechenov University.
Dr. Enikeev considers the process of active surveillance gradually ousting surgery in cases of early stages of cancers natural. “Even a minimally invasive procedure is still surgery with its inherent limitations. It is associated with risks of erectile dysfunction or urinary incontinence, for example. Research worldwide indicates that patients under active surveillance enjoy better quality of life and live longer than those who opted for surgery,” he said.
According to a large-scale trial published in New England Journal of Medicine, less than 2% of patients died of prostate cancer within a 10 year active surveillance period. The same rates were observed in patients with low-risk cancer who underwent radical treatment.
The trial aims at assessing multiple factors (e.g. smoking, exercise, genetic predisposition), conducting research into genetic markers, etc. “The results will provide clear guidelines that will be made readily available to the whole professional community,” promised Dmitry Enikeev.
Participation is voluntary, and any patient can drop out of the trial at any time regardless of the reasons for doing so. Surgical intervention may be indicated in cases of progression or if the patient is willing to take active steps. The follow up period is going to be 5 years.
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