“Urologists at University of California, San Diego School of Medicine and Genesis Healthcare Partners have tested a new model of care for patients with low-risk prostate cancer. The evidence-based approach uses best practices to appropriately select and follow patients to avoid disease overtreatment. Results of the three-year study are now published online in the journal of Urology.
” ‘Active surveillance is a strategy that is recommended by physician and quality organizations to avoid the overtreatment of slow-growing prostate cancer,’ said Christopher Kane, MD, senior author and chair of the Department of Urology at UC San Diego Health. ‘Acceptance of this strategy by patients and urologists, however, has lagged for a number of reasons. What we have developed is a safe method to enhance acceptance and use of this disease management approach.’ ”
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“Dan Woska was weighing his treatment options after he was found to have prostate cancer two years ago when a friend mentioned a new genomic test that could gauge how lethal his tumor was.
“The test, called Oncotype DX, which looks at the expression of 17 genes in a tumor, cost about $4,000 and was not covered by Mr. Woska’s insurance. But through a patient assistance program, the company that created it, Genomic Health, ran it for him free, using a tiny grain of tissue left over from his biopsy. The results indicated there was an 81 percent probability that Mr. Woska’s tumor would not spread beyond the prostate. On an aggressiveness scale of zero to 100, the tumor was an indolent 15.
“Thrilled and relieved, Mr. Woska decided to forgo radiation and surgery.”
“In cancer, as in other areas of medicine, early detection can save lives. But the screening tests used to find early tumors also detect disease that would never cause problems – disease you’ll die with but not from. Managing those cases means giving potentially harmful treatment to patients who won’t benefit.
“DCIS, or ductal carcinoma in situ, is the poster child of this dilemma. Before routine mammograms, only about 1 percent of U.S. breast cancer cases were DCIS. Now nearly 65,000 women a year – about 22 percent of those with breast cancer – are diagnosed with DCIS.
“DCIS, also known as Stage 0 breast cancer, is not life-threatening, and not all cases will progress to invasive cancer. But because there is no reliable way to determine which ones will, nearly all DCIS is surgically removed with a lumpectomy or mastectomy (and sometimes the healthy breast is removed prophylactically). Most DCIS patients also are offered radiation and drugs.”
“New research suggests that a wait-and-watch approach for prostate cancer isn’t being used often enough, and that more men are being treated than may be necessary.
“Additionally, the researchers expressed concern about the numbers of men being treated with radiation therapy, regardless of their tumor specifics.
” ‘Too many men are being treated for prostate cancer, and too many are being treated with radiation therapy,’ said study lead author Dr. Karim Chamie, an assistant professor of urology at the University of California, Los Angeles.
“But, the researchers weren’t able to tease out clear reasons why these things might be happening.”
“Active surveillance of men with low-risk prostate cancer may be better for quality of life and is cost-effective compared with immediate treatment, reports a study published today in CMAJ Open.
“Prostate cancer is the most common cancer in Canadian men and the third leading cause of death from cancer. The incidence of prostate cancer, and associated economic costs, has increased 50% over the last three decades, although most cases are low to intermediate risk. Many cancers, despite being low-risk of progressing, are treated and overtreatment can affect patient quality of life.”
“Research at UCLA on a technique for detecting the earliest spread of melanoma, the deadliest form of skin cancer, has confirmed that the procedure significantly prolongs patients’ survival rates compared with traditional “watch and wait” techniques.
“The technique, which combines lymphatic mapping and sentinel-node biopsy, allows doctors to quickly determine whether the disease has spread, or metastasized, to the lymph nodes, which occurs in approximately 20 percent of patients. Patients with cancer in their lymph nodes may benefit from having their other nearby lymph nodes removed. For the other approximately 80 percent of patients in whom the tumors have not spread to the lymph nodes, the technique spares the patient from unnecessary surgery and its associated complications and substantial costs.”