“A new report on Swedish men with non-aggressive prostate cancer suggests that a lot more American men could safely choose to monitor their disease instead of seeking immediate radiation treatment or surgery.
“Published online October 20 in the Journal of the American Medical Association (JAMA) Oncology, the report shows that well over half of 32,518 men in Sweden diagnosed with prostate cancers least likely to spread chose monitoring during a recent, five-year period over immediate treatment.”
“In the UK ProtecT trial reported in TheNew England Journal of Medicine, Freddie C. Hamdy, FRCS, FMedSci, of the University of Oxford, and colleagues found no significant differences in prostate cancer–specific or overall mortality among men with clinically localized prostate cancer detected by prostate-specific antigen (PSA) testing who underwent active monitoring, surgery, or radiotherapy. Metastases and disease progression were more common with active monitoring. Median follow-up in the study was 10 years.”
“A new study published in The Journal of Urology revealed that African American men with Gleason score 3+3=6 prostate cancer (PCa) produce less prostate specific antigen (PSA) and have significantly lower PSA density (PSAD) than Caucasian men. These findings could have important implications when selecting patients for inclusion in active PCa surveillance programs.
“Prostate cancer remains the second leading cause of cancer death among men in the U.S., with nearly 30,000 deaths annually. According to the latest recommendations by the American Urological Association, PSA remains the only screening test to select men with unremarkable digital rectal examination in whom prostate biopsy should be considered. Deaths from prostate cancer have declined by about 40% since the advent of PSA screening in the late 1980s, and 40-70% of that decline may be attributable to screening. For early stage low grade disease, active surveillance, commonly called watchful waiting, is considered appropriate.”
“Long-term follow-up data supports the use of active surveillance for men with favorable-risk prostate cancer, according to prospective study results.
“These men should be informed of the the low likelihood of harm from their diagnosis and encouraged to consider active surveillance over a curative approach, according to researchers.
“H. Ballentine Carter, MD, director of the division of adult urology at the Brady Urological Institute and the Bernard L. Schwartz distinguished professor of urologic oncology at Johns Hopkins Medicine, and colleagues sought to assess the long-term outcomes for men with favorable-risk prostate cancer in a prospective, active surveillance program.”
“An increasing number of men diagnosed with low-risk prostate cancer are opting for active surveillance – closely monitoring their cancer – rather than aggressive treatment to avoid the debilitating potential side effects of surgery and radiation, such as erectile and urinary dysfunction.
“However, a new study by UCLA researchers has found that less than 5 percent of men who chose to forgo aggressive treatment are being monitored as closely as they should be, putting them in danger of their cancer progressing or metastasizing without their knowledge.
“The study, published today in the peer-reviewed journal Cancer, examined the records of 37,687 men diagnosed with prostate cancer from 2004 to 2007 who were followed through 2009. They found that of the 3,656 men diagnosed with prostate cancer who did not undergo aggressive treatment, only 166 men, or 4.5 percent, were being monitored appropriately, said Dr. Karim Chamie, the study’s first author and an assistant professor of urology at UCLA.”
“More U.S. physicians are sparing their low-risk prostate cancer patients from surgery, radiation and hormone therapy in favor of monitoring their patients over time — a strategy called watchful waiting, a new study shows.
“The number of low-risk patients who didn’t undergo treatment jumped from as low as 7 percent from 1990-2009 to 40 percent from 2010-2013, the study revealed. These findings indicate that more patients are being monitored to see if their conditions get worse.
“This is ‘excellent news’ about the popularity of ‘active surveillance,’ said study author Dr. Matthew Cooperberg, the Helen Diller Family Chair in Urology at the University of California, San Francisco.
” ‘We expected to see a rise in surveillance rates, but were surprised by the steepness of the trajectory,’ he said. ‘This really does represent a paradigm change, and it’s faster than the typical pace of medical evolution.’ “
“Monitoring prostate cancer (PC) by active surveillance (AS), with the expectation to initiate treatment if the cancer progresses, is a preferred initial option for men with low-risk PC and a life expectancy of at least 10 years. According to the results of a new study conducted at Brigham and Women’s Hospital (BWH), there is evidence to also support AS as an initial approach for men with favorable intermediate-risk of PC (men with no evidence of the cancer spreading beyond the prostate, a Gleason score of 3+4 or less and PSA, prostate-specific antigen, under 20). These findings are published online by JAMA Oncology.
” ‘We found that men with favorable intermediate-risk prostate cancer did not have significantly increased risks of death compared to men with low-risk prostate cancer,’ said Ann Caroline Raldow, MD, first author of the study and resident physician at BWH and the Harvard Radiation Oncology Program. ‘The clinical significance of our findings is that men with favorable intermediate-risk prostate cancer may also be able to avoid, or at least defer the side effects of, prostate cancer treatment, and enter an active surveillance program as an initial approach.’ “
“Active surveillance appeared safe and feasible for patients with favorable-risk prostate cancer, according to long-term follow-up of a prospective single-arm cohort study.
“Active surveillance has gained acceptance for patients with favorable-risk prostate cancer because it may reduce the risk for overtreatment of clinically insignificant disease, while still allowing for definitive therapy for patients whose risk appears to increase over time. However, long-term follow-up on this approach is lacking, according to background information provided by researchers.
“In the current study, Laurence Klotz, MD, FRCS(C), chief of the division of urology at Sunnybrook Health Sciences Centre and professor in the department of surgery at the University of Toronto, and colleagues reported long-term outcomes of a large cohort of men who underwent active surveillance.
“The study included 993 men (median age, 67.8 years; range, 41-89) with favorable- or intermediate-risk prostate cancer treated at a single academic health sciences center.”
“Specialists who treat prostate cancer agree that active surveillance is an effective option—yet most don’t recommend it when appropriate for their own patients, according to a study in the July issue of Medical Care .
“Rather, urologists are more likely to recommend surgery and radiation oncologists are more likely to recommend radiation therapy—the treatments provided by their own specialties. ‘Given the growing concerns about the overtreatment of prostate cancer, our study has important policy implications about possible barriers to promoting active surveillance and specialty biases about optimal treatment regarding localized prostate cancer,’ comments Dr Simon P. Kim of Yale School of Medicine.”