Treatment for prostate cancer can wait for most men, study says

Researchers have found long-term evidence that active surveillance of localized prostate cancer is a safe alternative to immediate surgery or radiation.

The results, released Saturday, are encouraging for men looking to avoid treatment-related sexual and incontinence problems, said Dr. Stacy Loeb, a prostate cancer specialist at NYU Langone Health, who was not involved with the research.

The study directly compared the three approaches – surgery to remove tumors, radiation and surveillance. Most prostate cancers grow slowly, so it takes many years to see the consequences of the disease.

“There was no difference in mortality from prostate cancer between the groups at 15 years,” Loeb said. And prostate cancer survival was high for all three groups — 97%, regardless of treatment approach. “That’s also very good news.”

The findings were published Saturday in the New England Journal of Medicine and were presented at a European Association of Urology conference in Milan, Italy. The UK’s National Institute for Health and Care Research paid for the research.

Men diagnosed with localized prostate cancer shouldn’t panic or rush treatment decisions, said lead author Dr. Freddie Hamdy from the University of Oxford. Instead, they should “carefully weigh the potential benefits and harms caused by the treatment options.”

A small number of men with high-risk or more advanced conditions require urgent treatment, he added.

Researchers followed more than 1,600 British men who agreed to be randomly assigned to surgery, radiation or active surveillance. The patients’ cancers were confined to the prostate, a walnut-sized gland that is part of the reproductive system. Men in the surveillance group had regular blood tests, and some underwent surgery or radiation.

Death from prostate cancer occurred in 3.1% in the active surveillance group, 2.2% in the surgery group, and 2.9% in the radiation group, with differences considered not statistically significant.

At 15 years, cancer had spread in 9.4% of the active surveillance group, 4.7% of the surgical group, and 5% of the radiation group. The study began in 1999, and experts said today’s surveillance practices are better, with MRI imaging and genetic testing guiding decisions.

“We now have more ways to detect that the disease is progressing before it spreads,” Loeb said. In the US, approximately 60% of low-risk patients elect to use surveillance, now referred to as active surveillance.

Hamdy said the researchers saw the difference in cancer spread at 10 years and expected that it would make a difference in survival at 15 years, “but that wasn’t the case.” He said spread alone does not predict death from prostate cancer.

“This is a new and interesting finding that will be useful for men when making treatment decisions,” he said.


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