Treat or Monitor Early Prostate Cancer? 10-Yr Survival Same

Excerpt:

“Men with early prostate cancer who choose to closely monitor their disease are just as likely to survive at least 10 years as those who have surgery or radiation, finds a major study that directly tested and compared these options.

“Survival from prostate cancer was so high—99 percent, regardless of which approach had—that the results call into question not only what treatment is best but also whether any treatment at all is needed for early-stage cases. And that in turn adds to concern about screening with PSA blood tests, because screening is worthwhile only if finding cancer earlier saves lives.”

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More Men With Early Prostate Cancer Are Choosing to Avoid Treatment

Excerpt:

“Seemingly overnight, treatment of men with early-stage prostate cancer has undergone a sea change. Five years ago, nearly all opted for surgery or radiation; now, nearly half are choosing no treatment at all.

“The approach is called active surveillance. It means their cancers are left alone but regularly monitored to be sure they are not growing. Just 10 percent to 15 percent of early-stage prostate cancer patients were being treated by active surveillance several years ago. Now, national data from three independent sources consistently finds that 40 percent to 50 percent of them are making that choice.”

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Active Surveillance Follow-Up for Prostate Cancer Lacks Consistency

Excerpt:

“Only one in three men with prostate cancer received care in accordance with guidelines for active surveillance, according to a new study presented at the American Urological Association annual Meeting, held May 6–10 in San Diego. The use of active surveillance is increasing, but these results suggest quality improvement is needed.

“ ‘Although [active surveillance] for prostate cancer implies a plan to follow patients over time with repeated testing for disease progression, little is known about the rigor of such follow-up outside of specific academic protocols,’ wrote study authors led by Gregory B. Auffenberg, MD, of the University of Michigan in Ann Arbor.

“The study included 431 patients diagnosed with prostate cancer in the Michigan Urological Surgery Improvement Collaborative (MUSIC), a consortium of 42 practices with a prospective clinical registry.”

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A Better Prostate-Cancer Test?

Excerpt:

“When Al Piazza learned he had prostate cancer, his first thought was, ‘Let’s get this out and be done with it,’ he says. But his urologist, Jeremy Lieb, said the side effects of treatment could be more harmful than the cancer itself.

“Dr. Lieb ran a genetic test on the patient’s biopsy sample, which calculated that Mr. Piazza, then 70 years old, had only a 3% chance of dying from prostate cancer over the next 10 years if he left the tumor untreated.

“Four years later, the retired AT&T manager from Discovery Bay, Calif., has been monitoring his cancer with regular blood tests and imaging scans and says he is comfortable leaving it alone. ‘My feeling is—it’s there, but it’s not going to kill me,’ Mr. Piazza says.”

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New Model for Active Surveillance of Prostate Cancer Tested

Excerpt:

“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 ,’ said Christopher Kane, MD, senior author and chair of the Department of Urology at UC San Diego Health. ‘Acceptance of this strategy by  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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Prostate Cancer Surveillance Criteria May Not Be Accurate for African American Men

“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  among  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  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.”


Big Jump in Surveillance for Older Prostate Ca Patients

“Three out of four older men with low-risk prostate cancer opted for active surveillance during a 4-year period ending in 2013, according a large prostate cancer database.

“After bottoming out at 22% during 2000 through 2004, active surveillance was the initial option for newly diagnosed low-risk prostate cancer among men 75 or older from 2010 through 2013.

“Rates of active surveillance among men of all ages mirrored those of the older subgroup but remained much lower overall. From 1990 through 2009, the proportion of men in the 10,472-patient cohort entering active surveillance ranged from 6.7% to 14.3%. The rate increased sharply from 2010 to 2013, topping out at 40.4%, as reported online in JAMA.

” ‘In this analysis of a longstanding national registry, we found that after years of overtreatment for patients with low-risk prostate cancer, rates of active surveillance/watchful waiting for low-risk disease increased sharply in 2010 through 2013,’ Matthew R. Cooperberg, MD, and Peter R. Carroll, MD, of the University of California San Francisco, wrote in conclusion.”


'Watchful Waiting' Common for Prostate Cancer

“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.’ “


Are Too Many Prostate Cancer Patients Receiving Treatment?

“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.”