고든씨는 전립선암이 조사검과 암조직이 있을수도 있다는 판정을 받았다. 그는 지금,계속해서 6개월간 지켜보면서 검사를 해야 하느냐? 아니면 더많은 조직검사를 해서,심한 경우에는 목숨까지 앗아갈수 있는 암이 있는지확인하여 치료를 해야 할것인가? 기로에 서있다. 그는 가능하면 수술을 피하고 싶다 왜냐면 부부관계에 치명적일수 있기 때문이다 한편으로는 검사를 피하다 종국에는 생명까지 잃는 도박도 피하고 싶기 때문이다. 더 많은 내용은 아래 원문기사를 참조. Prostate cancer: Wait and watch - or not? LISA PRIEST From Thursday's Globe and Mail November 1, 2007 at 9:29 AM EST Faced with a test result showing he could have prostate cancer, Murray Gordon had a choice: He could wait and repeat the test in six months, or begin more medical investigations to determine if he had a cancer that may - or may not - ultimately harm him. It wasn't a decision he came to easily. Mr. Gordon, 59 at the time, didn't want to subject himself to an operation that carries risks of incontinence and erectile dysfunction, particularly if he had a low-grade, indolent tumour. Yet he didn't want to miss out on treating what might be an aggressive cancer that could kill him. Like thousands of Canadian men each year, Mr. Gordon was faced with difficult choices after learning in 2004 that the prostate-specific antigen test he took showed him to be on the high end of normal. Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. The test measures PSA levels in the blood. Elevated PSA levels could indicate that a cancer is growing in the prostate, although further tests are required to distinguish between a life-threatening tumour or a relatively benign one. "To me, you have to be a poker player with nerves of steel to know you have a condition in your body that could be lethal," Mr. Gordon said in a telephone interview from Carp, Ont. "My feeling is, because of the fact that the cancer can move very quickly and become aggressive very quickly, I couldn't rationalize waiting and hoping." According to Canadian Cancer Society figures, 22,300 men this year will be diagnosed with prostate cancer, a disease that is frequently diagnosed, largely due to the PSA test. But that test has become a victim of its own success, putting those with low-risk prostate cancer in a health-care conundrum. Aggressive treatment for a low-grade cancer is considered overkill, yet monitoring cancer with biopsies and PSA tests carries the risk of missing the window of curability. Laurence Klotz, chief of urology at Sunnybrook Health Sciences Centre in Toronto, said about 40 per cent of newly diagnosed prostate cancer patients are eligible for active surveillance. "The basic approach is to promote screening aggressively and being very conservative on the treatment side," Dr. Klotz said. "The only way to find the bad ones is to screen." Ideal candidates for active surveillance include those under 60 with a fairly low-grade prostate cancer, a PSA in the low to intermediate range and a biopsy that revealed a small volume of cancer. One of Dr. Klotz's patients, Tom LePoidevin, began surveillance of his prostate cancer 16 years ago at age 58. Now 74, he hasn't required any treatment for the disease and hopes he will die with prostate cancer - not from it. "You wake up every once in a while, and say, 'God, I do have prostate cancer,' but you get over that," Mr. LePoidevin said in a telephone interview from his home in Collingwood, Ont. His advice is: "Don't go under the knife too soon." The approach taken by Mr. Le Poidevin is currently being tested in a randomized controlled study called the Surveillance Therapy Against Radical Treatment trial. It is recruiting 2,130 newly diagnosed patients with low-risk prostate cancer in Canada, the United States, England and Europe. Funded in part by the Canadian Cancer Society and run by the National Cancer Institute of Canada's Clinical Trials Group, the study will compare standard treatment for prostate cancer to active surveillance. Half of patients will be randomly selected for treatment, such as surgery or radiation, and the other half will undergo active surveillance, which includes physician visits, PSA tests, digital rectal exams and biopsies. Results likely won't be known for 15 years, but it will provide the answer to a question no urologist today can answer with certainty: Which patients benefit from aggressive treatment at diagnosis? Dr. Klotz, the study's lead researcher, stressed that active surveillance should not be confused with "nobody should be treated." Those with intermediate- or high-grade cancers do benefit from treatment. The key, he said, is to be selective and treat the right patients. Of the 500 patients he has put under active surveillance, some have died - but almost all from other causes - Dr. Klotz said. Only three have died of prostate cancer, and all three had very aggressive disease for which earlier intervention would not have made a difference. Not one patient, he said, died a preventable death. Over all, about 25 per cent of patients who are put under active surveillance will eventually require treatment for their prostate cancer, he said. "There's quite a good acceptance by this approach," Dr. Klotz said. "But there are some [in the medical community] who think it's wrong. They think you are sacrificing patients' lives by under-treating them. I'm put on panels to debate these guys constantly." One such urologist he has debated is William Catalona, director of the clinical prostate cancer program at Northwestern University's Comprehensive Cancer Center in Chicago, who is perhaps best known for developing the PSA test. One of the problems with active surveillance, Dr. Catalona said, is that there is no consensus on when urologists should intervene. His concern is that waiting can mean delaying treatment, or worse - having patients become incurable. "Anywhere from 15 to 30 per cent of the patients, when you remove the prostate, you find out it was a lot worse than you thought," Dr. Catalona said in a telephone interview from Chicago. The problem for some men, especially those who are feeling healthy, is that a diagnosis of prostate cancer and a recommendation of surgery "turns their world upside down." That, he said, is why active surveillance is so attractive to many of them. "Really the best thing, especially for a young person with a long life expectancy, is to get it out and never have to deal with it again," Dr. Catalona said. "[The surgery is] not bad if it's done by an experienced surgeon who has good results." Though studies show roughly half who undergo the operation suffer erectile dysfunction afterward, a surgeon who specializes in the operation has much better outcomes. Specifically, 95 per cent of men in their 40s who undergo the operation under Dr. Catalona will recover their erections; that figure drops to 85 per cent of men who get the surgery in their 50s and 75 per cent of men who undergo the operation in their 60s. Overall, incontinence is less than 5 per cent in his surgical hands. With active surveillance, Dr. Catalona said: "Some patients are going to slip between the cracks and die a terrible death of prostate cancer. And that's awful." It was that fear three years ago that prompted Mr. Gordon to start medical investigations and find out if there was something wrong with his prostate, a walnut-sized gland that surrounds the neck of a man's bladder and urethra. After his PSA test revealed he was at the high end of normal, he decided to take the "percent-free" PSA test, a further blood test that can help distinguish between an elevated PSA due to an enlarged prostate and one resulting from cancer. Since Mr. Gordon's test indicated he may indeed have cancer, he required a biopsy. That biopsy confirmed that he had prostate cancer. Ultimately, he decided on a radical prostatectomy (surgical removal of the prostate gland), which he had in February, 2005, at The Ottawa Hospital. His tumour turned out to be intermediate, so surgery, he said, was the right decision. "My feeling," said Mr. Gordon, now 62, "is that I wanted to deal with it when it was still curable."