Too Few Men With Low-Risk Prostate Cancers Get 'Watch and Wait' Approach

Study finds 12 percent or fewer getting active surveillance

Tuesday, June 30, 2015

TUESDAY, June 30, 2015 (HealthDay News) -- A wide majority of U.S. men with low-risk prostate cancer are being treated for the disease even though "active surveillance" is an option, a new report finds.

Active surveillance -- or watchful waiting -- is the careful monitoring of prostate cancer for progression of the cancer that would indicate a need for treatment. Men in the Northeast and on the West Coast were especially likely to have active surveillance rather than cancer treatment, potentially sparing them from complications associated with treatment.

The study data was collected in 2010 and 2011, and a lot has changed since that time in regard to the popularity of active surveillance, experts noted.

Active surveillance is "gaining acceptance among urologists and patients," said study co-author Dr. Hui Zhu, chief of urology at the Louis Stokes Cleveland VA Medical Center in Ohio.

"Age-appropriate men should discuss the risks and benefits of screening with their physicians, and men with newly diagnosed localized prostate cancer should ask their physicians whether active surveillance is a good option for them," he added.

There's been controversy for years about diagnosing and treating prostate cancer. Tumors considered to be low-risk may never spread, but men have often been treated anyway. But, those treatments aren't without risk. Prostate cancer treatments can cause serious and lasting side effects, such as incontinence and erectile dysfunction, according to the American Cancer Society.

In 2011, the U.S. Preventive Services Task Force discouraged the use of routine prostate cancer testing. One reason why was because of the odds that low-risk tumors would be treated. But, despite that recommendation, many doctors continue ordering the prostate-specific antigen (PSA) tests. Supporters of the test suggest that if the PSA leads to an overdiagnosis of low-risk prostate cancers, that problem can be countered with active surveillance, the study authors noted.

The new report examines a national database that includes about 70 percent of cancer cases in the country.

Of nearly 190,000 mean diagnosed with prostate cancer, between 11 percent and 40 percent would be considered low-risk enough to be eligible for watch-and-wait approach. (There isn't a consensus about which patients should consider this strategy, and the report looks at different cut-off points.) Of those men, just 7 percent to 12 percent had active surveillance, the study revealed.

Older men -- those over 60 -- were more likely to have active surveillance. Men without insurance were also more likely to have active surveillance, the study said.

The researchers found that watchful waiting was most common on the West Coast and in the Northeast. The states with the lowest levels -- under 5 percent -- were Alabama, Mississippi, Tennessee and Kentucky.

Dr. Stephen Freedland, a urologist and director of the Center for Integrated Research in Cancer and Lifestyle at Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute in Los Angeles, pointed out that the report's data is outdated. The situation has "changed dramatically" over the past few years, with early research suggesting that many more men are choosing the surveillance option.

Before, he said, doctors chose treatment instead of monitoring because they weren't comfortable with watchful waiting and "didn't fully appreciate how well the patients do; how safe it is to do that."

He said it's rare for patients to simply never come back after being diagnosed.

Also, he said, "there was no imperative, no push to do it. It's a counterintuitive thing to say 'You have cancer, but I'm not going to do anything.'"

So, where does that leave men with low-risk prostate cancers?

"Prostate cancer, even the lethal form, is highly treatable when it is detected at an early stage through the use of screening," Zhu said.

"Men aged 55 to 69 years who are considering being screened for prostate cancer should have a discussion with their physicians which involves weighing the benefits of preventing death from prostate cancer against the known potential harms associated with screening and treatment," Zhu added.

The report was published online June 29 in the journal JAMA Internal Medicine.

SOURCES: Hui Zhu, M.D., Sc.D., assistant professor, Case Western Reserve University, and chief of urology, Louis Stokes Cleveland VA Medical Center, Ohio; Stephen Freedland, M.D., urologist and director, Center for Integrated Research in Cancer and Lifestyle and co-director, Cancer Genetics and Prevention Program, Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles; June 29, 2015, JAMA Internal Medicine, online

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