According to a decade-long study, many men with prostate cancer can delay or skip harsh treatments, such as surgery or radiation, without affecting their chances of survival.
Instead, they can have their cancer “actively monitored” after diagnosis, rather than having to have their prostate removed or exposed to high-energy radiation. Such treatments can cause long-lasting side effects such as urinary leakage, erectile dysfunction, and other urinary, bowel, and sexual problems.
“The good news is that when you’re diagnosed with prostate cancer, don’t panic and take your time to make a decision,” the study’s lead author said dr Freddie Hamdy (opens in new tab)Professor of Surgery and Urology at the University of Oxford CNN (opens in new tab). Crucially, this advice only extends to people with low- and intermediate-risk prostate cancer — those with high-risk cancer still need prompt and aggressive treatment, he said.
The new study, published Saturday (March 11) in the New England Journal of Medicine (opens in new tab), enrolled more than 1,600 men in the UK who had been diagnosed with prostate cancer and who were aged between 50 and 69 at the start of the study. These patients were randomized into three groups, which received different cancer treatments: one-third had their prostate removed, one-third underwent radiation combined with short-term hormone-blocking treatment, and one-third underwent active surveillance, which is now common as “active surveillance.”
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During the study, which began in 1999, active surveillance meant regularly measuring the levels of a particular protein in the patients’ blood. Levels of this protein, called prostate-specific antigen (PSA), tend to rise as prostate cancer progresses. Today, active surveillance can include additional tests, such as B. Magnetic resonance imaging (MRI) scans of the prostate and genetic testing, dr Olivier Sartor (opens in new tab)medical director of the Tulane Cancer Center, wrote in a comment (opens in new tab) the research.
The researchers followed each participant for 11 to 21 years after diagnosis and found that all patients had a similarly low risk of death, regardless of the treatment they received. Overall, 45 participants or 2.7% died from prostate cancer. This included 12 people (2.2%) in the surgical group; 16 people (2.9%) in the radiation group; and 17 people (3.1%) in the active surveillance group; these small differences are not considered statistically significant.
During the approximately 15-year follow-up period, approximately 330 men in the surveillance group, or 60%, eventually received either surgery or radiation. But waiting for treatment didn’t seem to affect her risk of death. In addition, 133 people in the surveillance group never had surgery, radiation, or hormone-blocking therapy and still survived.
Fifteen years after diagnosis, the cancer had metastasized or spread in 9.4% of the active surveillance group, 4.7% of the surgical group, and 5% of the radiation group. However, the control group might have performed better if the study had been conducted using today’s methods of monitoring, dr Stacy Loeb (opens in new tab)a prostate cancer specialist at NYU Langone Health who was not involved in the research explained The Associated Press (opens in new tab). “We now have more ways to detect that the disease is progressing before it spreads,” Loeb said.
It is important to note that “the vast majority of study patients were low-risk or favorable intermediate-risk and would be considered suitable candidates for active surveillance today,” and only a small fraction of study participants would be considered high-risk and in need of immediate treatment , Sartor wrote in his commentary.
In general, high-risk prostate cancer diagnoses account for only 15% of cases — so prostate cancer is low- to intermediate-risk most of the time, CNN reported. In low-risk patients, the potential risks and benefits of surgery and radiation should be carefully weighed because “more aggressive therapy may do more harm than good,” the study authors concluded.