Monitoring, Not Treatment, May Be Better for Some Prostate Cancer Patients

In Sweden, 90 percent with very low risk disease choose this option instead of immediate treatment, researchers report

Thursday, October 20, 2016

THURSDAY, Oct. 20, 2016 (HealthDay News) -- More than 90 percent of men in Sweden who have very low-risk prostate cancer choose close monitoring rather than immediate treatment -- and more American men should use that option, researchers say.

In a study of nearly 33,000 Swedish men with very low-risk (stage T1) prostate cancer diagnosed between 2009 and 2014, the number choosing what is called active surveillance increased from 57 percent to 91 percent during that time frame.

"For men who are diagnosed with low-risk prostate cancer, it is important to know that active surveillance is an accepted way to manage the cancer," said lead researcher Dr. Stacy Loeb. She's an assistant professor in the departments of urology and population health at NYU Langone's Perlmutter Cancer Center in New York City.

"There is no rush to get treatment -- low-risk prostate cancer can be safely monitored," she added. "Some men will eventually need treatment, but others will be able to preserve their quality of life for many years."

In the United States, the majority of men with low-risk prostate cancer get treatment upfront, which can have side effects, such as urinary and erectile problems, Loeb said.

Active surveillance isn't wait-and-see, she explained. It involves regular blood tests and regular biopsies to gauge the growth of the tumor. When the tumor grows to a point where treatment is needed, then it's time for curative surgery or radiation.

A recent British trial showed that 10 years after diagnosis, the risk of dying from prostate cancer was the same whether men initially had surgery or radiation or opted for monitoring, Loeb added.

"We found that most men in Sweden with low-risk cancers are now opting for surveillance rather than upfront treatment," Loeb said. "Hopefully, this study can increase awareness among patients in the U.S. and other countries that deferring treatment is an accepted option for low-risk prostate cancer."

The report was published online Oct. 20 in the journal JAMA Oncology.

There is a lot of controversy about prostate cancer screening, Loeb noted. "Prostate cancer has no symptoms until it is advanced, so screening is actually very important to find life-threatening cancers in time for cure," she said.

Patients with high-risk cancer do need treatment right away, and that treatment can be lifesaving, Loeb said. "However, many other men are diagnosed with low-risk cancers that have a very good prognosis without any treatment, and deferring upfront treatment can allow them to preserve their quality of life longer," she said.

About 181,000 American men will be diagnosed with prostate cancer in 2016, and most of those will be in the earliest stages, according to the U.S. National Cancer Institute. Approximately 26,000 men will die from prostate cancer in 2016, the NCI estimates.

The five-year survival rate for prostate cancer is nearly 99 percent, the NCI says.

"This [study] is more evidence of active surveillance becoming a standard of care," said Dr. Matthew Cooperberg. He's an associate professor of urology, epidemiology and biostatistics at the University of California, San Francisco and author of an accompanying journal editorial.

Sweden has been far ahead of the United States in terms of active surveillance, but it is becoming more accepted here, Cooperberg said. About 40 percent to 50 percent of men with low-risk prostate cancer are choosing surveillance, "so we still have some catching up to do," he said.

Adoption of active surveillance has been slow in the United States for several reasons, Cooperberg added. Among these are the financial and legal incentives to treat patients.

"In addition, culturally Americans have been uncomfortable with the idea of not treating cancer, because of the psychology that comes with the 'C' word," he said. "But things are changing; it's not such a foreign concept."

Cooperberg said the future of active surveillance is refining it based on an individual's cancer, so that tests and biopsies aren't done on an arbitrary schedule, but on a schedule based on the characteristics of the patient's tumor.

"Prostate cancer decision-making -- from PSA testing on through treatment -- really needs to be personalized," he said.

SOURCES: Stacy Loeb, M.D., assistant professor, departments of urology and population health, NYU Langone, Perlmutter Cancer Center, New York City; Matthew Cooperberg, M.D., associate professor, urology, epidemiology and biostatistics, University of California, San Francisco; Oct. 20, 2016, JAMA Oncology, online

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