Prostate Cancer Patients Can Delay Aggressive Care

"Many prostate-cancer patients could delay or forgo radical treatment without compromising quality of life or longevity, a study showed, adding to a reconsideration of how aggressively to treat some common cancers.

Men with low-grade and some with moderate-grade localized prostate cancer could safely choose surveillance over surgery or radiation, according to a study published on Saturday in the New England Journal of Medicine. Its authors followed about 1,600 men in the U.K. diagnosed with localized prostate cancer for a median of 15 years. They found that mortality was low whether patients received radiotherapy, a prostatectomy or active monitoring: 3% of patients in the study died from prostate cancer.

The length and breadth of the study confirms that surveillance is sufficient to manage early-stage prostate cancer for many patients, said Matthew Smith, director of the Genitourinary Malignancies Program at the Massachusetts General Hospital Cancer Center in Boston.

"This is truly a landmark study in prostate cancer," said Dr. Smith, who wasn't involved in the research.

Around 31,600 men in the U.S. died of prostate cancer in 2019, according to the Centers for Disease Control and Prevention. It is the second-most-common cancer among men in the country after skin cancer and disproportionately affects Black men. Some 2% of patients in the U.K. study identified as nonwhite.

Patients in the study's monitoring group, who were routinely tested for the level of prostate-specific antigen in their blood instead of undergoing surgery or radiation, experienced more spread of their cancer than patients who received more intensive therapies. 

But death rates across the groups that received radiation, surgery or regular surveillance were similar, the researchers found.

"Everybody expected that the curves would separate and would start to see a survival advantage for men who receive radical treatment, and that's not happened," said Dr. Freddie Hamdy, professor of surgery and urology at the University of Oxford and a co-author of the study. "That was a big surprise."

At the outset of the study, around two-thirds of men had low-risk disease and one-third had moderate-risk disease. Results of the study were originally published after a median of 10 years of data was collected in 2016.

Active monitoring evolved over the years the study was conducted. Today it can consist of tests including a prostate-cancer screening test, genomics testing of the tissue or blood, advanced imaging and biopsy when required. Around half of the monitored patients in the study were referred for treatment and underwent radiation or surgery, delaying but not forgoing more radical treatment.

Patients who undergo radical treatment can experience side effects including urinary incontinence, rectal pain, bowel urgency and erectile dysfunction. An accompanying paper published Saturday in the New England Journal of Medicine Evidence, based on patient-reported information, shows how the side effects of treatment vary over time for surgery, radiation and monitoring.

The study reinforces the idea that active surveillance is the preferred treatment for low- and some intermediate-risk prostate cancer, said Behfar Ehdaie, a urological oncologist and prostate-cancer surgeon at Memorial Sloan Kettering in New York, who wasn't involved in the study. He said the findings can reassure patients and physicians that active surveillance is the right choice for many.

"We will delay surgery and radiation in these patients, which will lead to improved quality of life," said Dr. Ehdaie." [1]

 

1. U.S. News: Prostate Cancer Patients Can Delay Aggressive Care
Perez-Castells, Ariana.  Wall Street Journal, Eastern edition; New York, N.Y. [New York, N.Y]. 13 Mar 2023: A.5.