Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
The widely used screening for prostate cancer with prostate specific antigen has resulted in identification of potentially lethal prostate cancers at a much more curable stage and has been associated with significant falls in prostate cancer mortality. In spite of the fact that prostate cancer is one of the deadliest malignancies in men, the advent of sensitive diagnostic testing has also resulted in detection of low risk cancers due to the high incidence of latent prostate cancer in aging men and prolonged natural history of the disease. This, in turn, has entailed the problem of cancer overdiagnosis and subsequent overtreatment. Approximately 6 times as many men will be diagnosed
with the disease as will die from it. Active surveillance appeared as a response to the clearly documented risks of overdiagnosis and overtreatment of low risk prostate cancer for localized prostate cancer. It entails initial expectant management rather than immediate therapy, with ‘curative-intent’ treatment deferred until there is evidence that the patient is at an increased risk of disease progression. This approach attempts to balance the risks and side effects of overtreatment against the possibility of disease progression and lost opportunity for cure. A systematic literature review brings current knowledge on the subject.Široka uporaba za prostatu specifičnog antigena (PSA) rezultirala je otkrivanjem potencijalno smrtonosnih karcinoma prostate u nižem, lječivom stadiju te je povezana sa značajnim padom smrtnosti od raka prostate. Unatoč činjenici da je rak prostate jedna od najsmrtonosnijih malignih bolesti u muškaraca, pojava osjetljivih dijagnostičkih testova također je rezultirala otkrivanjem karcinoma niskog rizika zbog visoke učestalosti latentnog raka prostate u muškaraca starije dobi i dugog prirodnog tijeka bolesti. Dakle, pojavio se i problem pretjeranog dijagnosticiranja indolentne bolesti i posljedičnog suvišnog liječenja. Kod šest puta više ljudi će biti dijagnosticirana bolest nego što će ih umrijeti od nje. Aktivni nadzor pojavio se kao odgovor na jasno dokumentirani rizik pretjerane dijagnoze i pretjeranog liječenja kod lokaliziranog raka prostate niskog rizika. To podrazumijeva početno praćenje s odgodom “pristupa s namjerom liječenja” dok se ne pojave dokazi povećanog rizika za progresiju bolesti. Ovaj pristup pokušava uravnotežiti rizike i nuspojave pretjeranog liječenja u odnosu na mogućnost napredovanja bolesti i izgubljenu priliku za liječenje. Sustavni pregled literature donosi današnje spoznaje o ovoj temi
