The gist: Certain women with lobular neoplasia may not have to undergo surgery to remove it. Lobular neoplasia is a breast condition that indicates a higher risk of later breast cancer. Lobular neoplasia is often removed by surgery. But new research says that with a careful approach, women with classic lobular neoplasia may be treated effectively with observation and possibly drugs to prevent breast cancer. These women can avoid the potential risks of surgery.
“Surgical excision of classic lobular neoplasia diagnosed on calcification-targeting core biopsy can be avoided when careful imaging and pathology correlation is applied, according to results of a prospective study presented at the Breast Cancer Symposium.
“ ‘Lobular neoplasia, including atypical lobular hyperplasia or lobular carcinoma in situ (classic type), is a known pathologic marker of bilateral risk for subsequent breast cancer,’ Barbara Susnik, MD, of Virginia Piper Cancer Institute in Minneapolis, told HemOnc Today. ‘The management of lobular neoplasia identified on core biopsy is controversial, in that recommendations are not established and practices vary. We identified a subset of patients who can avoid surgical excision: patients with lobular neoplasia identified on stereotactic core biopsy, who presented with calcifications on mammography.’
“Susnik and colleagues analyzed 13,772 percutaneous breast core biopsy procedures performed between June 2008 and December 2013.”
“Most older men with low-risk prostate cancer receive upfront treatment, despite absence of clear survival benefit and potential for morbidity. In a retrospective cohort study reported in JAMA Internal Medicine, Hoffman et al found that use of observation as management in this setting varied widely among urologists and radiation oncologists. Patients diagnosed by urologists who treat prostate cancer were more likely to receive upfront treatment, which was also likely to be a treatment that the urologist performed.”
Numerous clinical studies have shown that African American men with prostate cancer often have more aggressive types of cancer than men of other races. Now, based on the results of a new clinical study, researchers suggest that observation with active surveillance may not be the best option for African American men diagnosed with low-risk prostate cancer. The study involved 256 black men, 1473 white men, and 72 men of other races who had their prostate glands surgically removed after being diagnosed with very low-risk prostate cancer. By analyzing the prostate tissue, researchers determined that 27 percent of black men actually had worse cancer than they were originally diagnosed with, compared to 14 percent of the white men in the study. The study does not change current treatment guidelines, but points to the need for more African American involvement in medical research.
According to a recent study published in the medical journal Annals of Internal Medicine, active surveillance and watchful waiting are both more effective and less expensive than immediate treatment for localized, low-risk prostate cancer. The analysis determined that the estimated lifetime risk of death from prostate cancer was 4.8% with active surveillance, 6% with watchful waiting, and 8.9% for initial treatment. The researchers note that as many as 60% of men who have initial treatment for low-risk prostate cancer may not have required any therapy during their lifetimes, and that most of these men will have at least one long-term adverse side-effect from treatment.
Men diagnosed with low-risk, or Gleason 6, prostate cancer are often prescribed frequent monitoring, termed active surveillance or ‘watchful waiting,’ as opposed to being aggressively treated. Two leading scientists debate the benefits of the practice: Dr. Laurence Klotz, from Sunnybrook Health Sciences Centre in Canada, says active surveillance ensures that patients aren’t misdiagnosed with low-risk prostate cancer when they actually have a higher-risk form of the disease, a mistake that occurs in 25% of patients. Active surveillance also allows clinicians to monitor patients for progression of prostate cancer and, most importantly, it reduces the rate of overtreatment of low-risk prostate cancer types, thereby reducing the risk of treatment complications. Dr. Oliver Sartor, a urologist from Tulane University School of Medicine, contends that the practice of active surveillance is not well defined and too complicated. It involves repeated testing and procedures and is not widely accepted or practiced by community urologists. He outlines two clinical studies that show no benefit of active surveillance on long-term survival, and suggests that patients with low-risk prostate cancer may be better served by simply treating their symptoms.
Results of a clinical trial that evaluated the prostate cancer vaccine Provenge have come under scrutiny. Questions arise regarding the reported 4-month survival benefit that ultimately led to FDA approval. Disputers suggest that a flaw in methods led to the survival benefit, but that the vaccine may actually cause harm.
A recent study evaluated the usefulness of surgery versus observation to treat localized prostate cancer. In the study, 731 men were followed for 10 years. Those treated with surgery did not have a significant decreased risk of death compared to those who were observed for advancing cancer.