Nav: Home

Study finds upsurge in 'active surveillance' for low-risk prostate cancer

February 11, 2019

Many men with low-risk prostate cancer who most likely previously would have undergone immediate surgery or radiation are now adopting a more conservative "active surveillance" strategy, according to an analysis of a new federal database by scientists from Dana-Farber Cancer Institute.

The use of active surveillance increased from 14.5 percent to 42.1 percent of men with low-risk prostate cancer between 2010 and 2015, said the researchers, led by Brandon Mahal, MD, from the department of radiation oncology at Dana-Farber/Brigham and Women's Cancer Center who led the study published by JAMA.

During that same period, the percentage of men undergoing radical prostatectomy (removal of the prostate gland) declined from 47.4 percent to 31.3 percent. The use of radiotherapy for low-risk disease dropped from 38.0 percent to 26.6 percent.

"What we know from high level evidence is that conservative management of low-risk prostate cancer is associated with a very favorable prognosis," said Mahal. "Many men with low-risk disease are able to be spared the toxicity of treatment so it's an important discussion to have between clinicians and patients."

National guidelines advocating conservative management rather than immediate "definitive treatment" with surgery or radiotherapy were established in 2010 for men with low-risk prostate cancer. Low-risk disease is defined as a small tumor confined to the prostate gland that is assigned a grade of 6 on the Gleason scale following a biopsy; an early pathological stage, and a low PSA (prostate-specific antigen) blood level.

"This encouraging finding suggests that clinicians are better adhering to current recommendations and guidelines for men with low-risk prostate cancer, as the use of active surveillance in appropriately selected men will reduce rates of overtreatment," said Howard Soule, PhD, executive vice president and chief science officer of the Prostate Cancer Foundation.

Mahal said men with low-risk tumors have a "very, very low risk of dying" from prostate cancer, and that invasive treatments don't necessarily improve survival odds. In the current study, Mahal and his colleagues, including senior author Paul Nguyen, MD, a Dana-Farber/Brigham and Women's Cancer Center radiation oncologist, made use of a federal database that for the first time specified whether patients made use of watchful waiting or active surveillance. (Patients adopting a watchful waiting approach are told to report symptoms such as changes in urinary habits, pain, or irritation, or bone pain that could reflect metastatic progression. Active surveillance involves periodic follow-up tests for PSA levels, repeat biopsies, and exams by a doctor every six to 12 months).

The study also revealed changes in treatment for high-risk prostate cancer from 2010 to 2015 - though the researchers were somewhat surprised by the findings. The use of radical prostatectomy increased from 38 percent to 42.8 percent during that period, while radiotherapy decreased from 60.1 percent to 55 percent.

"This shift in management patterns away from radiation therapy and toward more radical prostatectomy is not supported by any recent high-level studies," said Mahal. "This finding is provocative and may be a focal point of debate."
-end-
Funding for the research was provided by Prostate Cancer Foundation-American Society for Radiation Oncology award to Mahal; Prostate Cancer Foundation funding to Nguyen; and support from the Wood Family Foundation, Baker family, Freedman family, Fitz's Cancer Warriors, David and Cynthia Chapin, Frashure family, and other donors.

Dana-Farber Cancer Institute

Related Prostate Cancer Articles:

ASCO and Cancer Care Ontario update guideline on radiation therapy for prostate cancer
The American Society of Clinical Oncology (ASCO) and Cancer Care Ontario today issued a joint clinical practice guideline update on brachytherapy (internal radiation) for patients with prostate cancer.
Patient prostate tissue used to create unique model of prostate cancer biology
For the first time, researchers have been able to grow, in a lab, both normal and primary cancerous prostate cells from a patient, and then implant a million of the cancer cells into a mouse to track how the tumor progresses.
Moffitt Cancer Center awarded $3.2 million grant to study bone metastasis in prostate cancer
Moffitt researchers David Basanta, Ph.D., and Conor Lynch, Ph.D., have been awarded a U01 grant to investigate prostate cancer metastasis.
New findings concerning hereditary prostate cancer
For the first time ever, researchers have differentiated the risks of developing indolent or aggressive prostate cancer in men with a family history of the disease.
Prostate cancer discovery may make it easier to kill cancer cells
A newly discovered connection between two common prostate cancer treatments may soon make prostate cancer cells easier to destroy.
New test for prostate cancer significantly improves prostate cancer screening
A study from Karolinska Institutet in Sweden shows that a new test for prostate cancer is better at detecting aggressive cancer than PSA.
The dilemma of screening for prostate cancer
Primary care providers are put in a difficult position when screening their male patients for prostate cancer -- some guidelines suggest that testing the general population lacks evidence whereas others state that it is appropriate in certain patients.
Risk factors for prostate cancer
New research suggests that age, race and family history are the biggest risk factors for a man to develop prostate cancer, although high blood pressure, high cholesterol, vitamin D deficiency, inflammation of prostate, and vasectomy also add to the risk.
Prostate cancer is 5 different diseases
Cancer Research UK scientists have for the first time identified that there are five distinct types of prostate cancer and found a way to distinguish between them, according to a landmark study published today in EBioMedicine.
UH Seidman Cancer Center performs first-ever prostate cancer treatment
The radiation oncology team at UH Seidman Cancer Center in Cleveland performed the first-ever prostate cancer treatment April 3 using a newly-approved device -- SpaceOAR which enhances the efficacy of radiation treatment by protecting organs surrounding the prostate.

Related Prostate Cancer Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Bias And Perception
How does bias distort our thinking, our listening, our beliefs... and even our search results? How can we fight it? This hour, TED speakers explore ideas about the unconscious biases that shape us. Guests include writer and broadcaster Yassmin Abdel-Magied, climatologist J. Marshall Shepherd, journalist Andreas Ekström, and experimental psychologist Tony Salvador.
Now Playing: Science for the People

#513 Dinosaur Tails
This week: dinosaurs! We're discussing dinosaur tails, bipedalism, paleontology public outreach, dinosaur MOOCs, and other neat dinosaur related things with Dr. Scott Persons from the University of Alberta, who is also the author of the book "Dinosaurs of the Alberta Badlands".