USA TODAY International Edition
Hope for early- stage prostate cancer
Study: Men can delay aggressive treatment
Men with early- stage prostate cancer can safely hold off on aggressive treatment, confirms a new study that offers the longest- term treatment data yet.
“Watchful waiting,” more recently renamed “active surveillance,” has long been an option for men with early prostate cancer. But doctors didn’t know how long was safe to wait and men were often concerned they were taking a risk by delaying treatment.
The new research, published Saturday in The New England Journal of Medicine, shows that less than 3% of British men whose prostate cancer was detected early died of their disease within 15 years.
People who chose watchful waiting were no more likely to die than those who opted for surgery or radiation and they suffered no side effects, other than perhaps some anxiety.
“It’s a strong endorsement for active surveillance and reaffirms that our treatments for prostate cancer, when detected early, are very effective,” said Dr. Behfar Ehdaie, a surgeon at Memorial Sloan Kettering Cancer Center in New York City, who was not involved in the new study.
The new research also found little difference between the more aggressive treatment strategies.
It’s a strong endorsement for active surveillance and reaffirms that our treatments for prostate cancer, when detected early, are very effective.”
Dr. Behfar Ehdaie Memorial Sloan Kettering Cancer Center
What did the study find? Between 1999 and 2009 more than 82,000 British men ages 50 to 69 received a prostate- specific antigen or PSA test.
Of those, nearly 2,700 – just more than 3% – were diagnosed with localized prostate cancer.
As part of the ProtecT trial, most were randomly assigned to active monitoring, a prostatectomy, or radiation plus 3 to 6 months of androgen-deprivation therapy.
By the end of 15 years, 22% of the men had died from all causes and 2.7% from prostate cancer. In the active monitoring group, 9% of the tumors had spread, compared with half that many in the treatment groups.
But many men have sexual, urinary and bowel issues after surgery or radiation.
The ability to stratify prostate cancer into low- vs. high- risk has improved somewhat since the study began in 1999, according to researchers from Tulane Medical School in New Orleans, in an accompanying editorial.
Prostate specific membrane antigen positron- emission– tomographic or PSMA PET scans can be used to stage tumors.
Active surveillance methods have also improved, they noted.
“Taken together, the management of localized prostate cancer has undergone a wholesale change since 1999 when the ProtecT trial was started,” their commentary concluded. “Even so, the results of this trial provide valuable data to inform decision making in the large group of men with low- or intermediate- risk prostate cancer.”
Bottom line
The new research confirms the benefit of PSA testing, Ehdaie said, and, if early cancer is detected, for men to discuss options with their doctor.
“It’s a patient- specific discussion,” he said. “And it’s difficult to apply results from a general population in a study to a patient- specific condition.”
But those who choose active surveillance should find the study “reassuring,” he said.
Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.