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Active surveillance and watchful waiting in the treatment of prostate cancer

A multi-disciplinary team that works with the patient in the clinic Assuta, offer options for prostate cancer treatment in Israel. It includes a surgeon (urologist); A doctor who specializes in the field of radiation therapy,hormonal therapyand chemotherapy; nurses, physiotherapist.

Choose the best treatment option is not always easy to be taken into account a number of factors. The most important of these are general health, disease stage, PSA level, the potential side effects.

Knowing the stage of the disease, the doctor will determine the best treatment option.

There are a number of stage systems, a simplified version is as follows:

Step 1. The tumor is small and limited to the prostate gland. It can not detect during a rectal examination.

Step 2: The neoplasm palpable as a hard lump during a rectal examination, is localized in the prostate.

Stage 3. Cancer is beyond the boundaries of the prostate and spread to the seminal vesicles.

Step 4: The disease affects nearby structures - the bladder or the rectum, as well as more distant organs - the liver or bones.

A decision on the treatment of prostate cancer in Israel

It is not recommended to start treatment immediately instead of monitoring. There are two approaches: active surveillance and watchful waiting. Although blood tests and a biopsy can find prostate cancer at an early stage, it is impossible to say whether it will grow and whether the symptoms cause. Graduation on Gleason scale will be useful, as will give more information, but can not predict the exact result. In many cases, prostate cancer grows very slowly, and small tumors in the early stages may never cause problems in human life.


Do a biopsy, the doctor examines samples of cancer cells under a microscope to determine the degree of cancer. It varies depending on the emergence of new cells.

There are several systems of classification, but the Gleason score is used more often. It helps doctors to determine which treatment is best, as it gives much information about the disease, sets aggressive form of cancer. Refers to primary cells or secondary level. If the score is between 2 and 4, the tumor has a very low risk of aggression, from 5 to 7 - is a moderately aggressive, from 8 to 10 very aggressive form of cancer.

Treatment of prostate cancer in any way provoke side effects - problems with erection or urinary incontinence. May recommend a Doctors: wait to Resort to active A a surveillance to see Whether the cancer will of a cause Problems view, But not to start therapy immediately.

Watchful waiting for an early and localized prostate cancer

It is, in fact, watching and waiting - the way not to go as long as possible treatment.

His offer to elderly men or those whose tumor is slow-growing, for this reason, surgery and radiation therapy is not well suited. There are cases when elderly patients do not need treatment, the disease progresses very slowly and is unlikely to cause any symptoms.

The doctor makes status monitoring, checks to see if new symptoms appear, such as difficulty urinating or pain in the bones. Also, the patient regularly donates blood tests, diagnoses PSA and digital rectal exam passes.

If the symptoms of the disease develop, or PSA content is increasing, as a rule, appointed by hormone therapy. When the cancer progression of symptoms is not safe to continue watchful waiting.


Many patients who expressed a preference for this method, it is possible to avoid the complications and side effects of surgery or radiation therapy.


Some men it is difficult to accept that they have cancer, and the treatment is not carried out. If the disease is really starting to make progress, it is usually carried hormone that controls the disease, but does not eliminate it.

Active surveillance for early and localized prostate cancer at Assuta

This technique is closely monitoring the development of the disease, to identify where progress is significant.

prostate cancer in the early stages with a low risk of aggression are slow-growing and may never cause any symptoms. For this reason, some patients along with doctors decided to wait and see whether the disease progresses, before embarking on any treatment, ie, resort to active surveillance.

As a rule, held a digital rectal examination and blood tests every 1-3 months. If you develop new symptoms may be asked to conduct a prostate biopsy every few years.

When tests show that the cancer begins to grow, doctors recommend treatment, which aims to get rid of the disease - to conduct surgery or radiation therapy. If the disease does not progress, it is safe to continue active surveillance.


Many men who choose this method, are not subject to complications and side effects of surgery, radiation or hormone therapy.


For some patients, the complexity is waiting and watching, is la develop cancer before starting treatment. A number of men in any case need to be therapy.

Watchful waiting for locally advanced prostate cancer at Assuta

Some locally advanced prostate cancer develops very slowly, it is probable absence of any symptoms. It may be decided to wait and see whether the disease progressed.

A doctor at this time controls the state polls of possible signs, examines, conducts digital rectal examination. If you have concerns about growth, carried out further tests: blood tests for PSA, X-ray, MRI and bone scans.

If the diagnosis confirms the progression of the disease, discusses treatment options in Israel, which will focus on cancer control and improvement in symptoms. When growth is missing, continue to adhere to this methodology.


If you choose watchful waiting, patients can avoid the side effects of hormone therapy or radiation.


For some patients, it is very difficult to remain in a waiting state, not knowing whether the cancer has progressed, before starting treatment, especially because doctors can not predict it will happen or not. If the disease will show symptoms, therapy is in any case necessary.

Thus, when the disease develops very slowly, the patient is elderly, health is not good enough for surgery or radiation therapy, watchful waiting is recommended technique.

Young men in good health and tumors with low aggression may suggest active surveillance. If the disease is still progressing, it is advised surgery or radiation therapy to try to cure cancer. For example, active surveillance allows for treatment only to those who really need it.

It is important that the patient is aware of all the potential advantages, disadvantages and side effects of therapy, before making a decision. It must be remembered that each person responds differently to treatment. Doctors can not predict exactly what will cause unwanted effects these or other procedures.


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