Friday, October 28, 2016

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

More than 90% 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 to 91%.

“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.

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

A recent British trail 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.

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.

Sweden has been far ahead of the United States in terms of active surveillance, but it is becoming more accepted here, 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. About 40-50% 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.

My Take:
I believe the psychology that comes with the ‘C’ word was deliberately planted by the medical profession to gain support for invasive forms of treatment. The financial incentives to treat aggressively override any concerns about what is best for the patient.

Remember the triad of evidenced based medicine – scientific studies, clinical experience and patient preference. If the scientific studies don’t support your treatment, you must scare the patient into choosing the more aggressive path.

The Bottom Line:
As the patient, you must become educated and not allow fear to govern your health choices. All too often physicians ignore evidenced based studies for years, until patients begin to demand better treatment. I have had some clinical experience treating the incontinence and impotence that frequently occur from aggressive treatment of prostate cancer. These men really do lose much of their quality of life, often needlessly.

Source: October 20, 2016 National Institutes of Health

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