Active Surveillance May Benefit Men With Low-Risk Prostate Cancer

But report says more needs to be known about the long-term outcome of this approach

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Prostate Cancer

WEDNESDAY, Dec. 7 (HealthDay News) -- As more men are screened for and diagnosed with low-risk prostate cancer, a new draft report released Wednesday by a U.S. National Institutes of Health panel concluded that research on the safety of "active surveillance" is needed.

Once prostate cancer is discovered, many men opt for surgery or other treatments that can have negative effects on their quality of life, including erectile dysfunction, hot flashes and problems urinating. For many of these men active surveillance might be a better option, but little is known about the consequences of such a conservative strategy, the experts noted.

"Our panel found that many men with localized low-risk prostate cancer should be closely monitored permitting their treatment to be delayed until disease progression warrants it," Dr. Patricia A. Ganz, panel chairwoman and director of prevention and control research at the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles, said during an afternoon news conference.

Some men with prostate cancer will benefit from immediate treatment, but others will benefit from observation, she added.

The consensus of the panel was that many men could benefit from active surveillance. And it is one of the options that should be offered, according to the panel's draft report.

According to Ganz, more than 100,000 men who are diagnosed with prostate cancer each year in the United States would be candidates for active surveillance rather than immediate treatment.

But, there is no standard protocol recommending when a man should move from active surveillance to treatment, she said.

Active surveillance is not just monitoring PSA levels, but may involve several biopsies over time or scans to see if the cancer has grown, Ganz said. Often men are not given this option, and many men are reluctant to hold off on treatment, the panel noted.

"Among the recommendations are that we teach physicians to be able to communicate the possibility of a more conservative observational strategy to men who are candidates in this low-risk group with very limited disease," Ganz said.

Among patients, the word cancer tends to set off an emotional response that encourages them to chose a more active treatment, the panel noted.

There are still many unanswered questions, the panel said. Among these are: how to identify the patients who would benefit most from active surveillance; how such a program would be conducted; the best way to present this option to patients; the best way to help patients decide on this option; the reasons for opting for active surveillance vs. active treatment; and finding out the true outcomes of this approach.

After skin cancer, prostate cancer is the most common cancer in American men. The American Cancer Society estimates that for 2011: about 241,000 new cases of prostate cancer will be diagnosed, and roughly 33,720 men will die of the disease.

About one in six American men will be diagnosed with prostate cancer during his lifetime. More than 2 million men diagnosed with the disease at some point are still alive today, the society said.

SOURCES: Dec. 7, 2011, news conference with Patricia A. Ganz, M.D., professor, University of California, Los Angeles Schools of Medicine and Public Health, Dec. 7, 2011, U.S. National Institutes of Health Conference statement, Role of Active Surveillance in the Management of Men With Localized Prostate Cancer

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