Less than half of men with early stage prostate cancer for whom active surveillance is an option choose it, according to a new report on Swedish men with nonaggressive prostate cancer published in the Journal of the American Medical Association (JAMA) Oncology.1
However, an international team of researchers concluded that when active surveillance is presented as an option, men with early stage prostate cancer are likely to choose it. This approach uses regular blood tests, physical examinations, and periodic biopsy to monitor for signs of tumor growth before considering therapy. Active surveillance averts the risks of sexual dysfunction and bowel and bladder problems frequently associated with traditional treatments for men with very low-risk, low-risk, and intermediate-risk disease.
Because recent studies suggested that some men with early stage prostate cancer who opted to undergo treatment later regretted their decision related to lingering issues with incontinence and impotence, an international team led by researchers from NYU Langone Medical Center and its Perlmutter Cancer Center sought to determine whether more men would choose a nonaggressive treatment option such as active surveillance if it were presented to them.
For the study, the researchers analyzed data from the National Prostate Cancer Register (NPCR) of Sweden, which has data on 98% of prostate cancer cases in Sweden, to determine the extent of use of active surveillance for favorable-risk prostate cancer. The cross-sectional study included data on 32,518 men, median age 67 years, with very low-risk (4693 men), low-risk (15,403 men, including the men with very low-risk disease), or intermediate-risk (17,115 men) prostate cancer.
The study findings demonstrate that from 2009 to 2014 an increasing number of Swedish men with very low-risk prostate cancer (57% to 91%) or low-risk prostate cancer (40% to 74%) chose active surveillance, whereas the number of men in both groups who choose the passive practice of watchful waiting decreased by more than half. Watchful waiting is to simply wait — no further testing or therapy — unless symptoms develop.
The authors hope their findings will encourage cancer care clinicians to offer active surveillance to their patients with low-risk disease. If more American men with prostate cancer chose active surveillance, the harms of screening could be reduced by minimizing overtreatment of nonaggressive disease, the authors state.
Furthermore, recent studies showed no difference in death rates 10 years after diagnosis between patients who opted for active surveillance and those who opted for immediate treatment. Risk of side effects is greater among men who chose to undergo treatment; however, this effect was not confirmed among the Swedish men in this study.
1. Loeb S, Folkaljon Y, Currnyn C, Robinson D, Bratt O, Stattin P. Update of active surveillance for very-low-risk prostate cancer in Sweden. JAMA Oncol. 2016 Oct 20. doi: 10.1001/jamaoncol.2016.3600. [Epub ahead of print]