An increasing number of men with a diagnosis of low-risk prostate cancer are deciding for active surveillance — closely monitoring their cancer – instead of opting for aggressive treatments to avoid the side effects of surgery and radiation, including erectile and urinary dysfunction. However, results from a recent study published in the journal Cancer, indicate that less than 5% of men who opt to forgo aggressive therapy are being monitored appropriately, placing them at risk of their cancer progressing or metastasizing.
In the article titled “Population-based assessment of determining predictors for quality of prostate cancer surveillance,” Karim Chamie MD and colleagues from UCLA conducted a population-based study to assess the quality of active surveillance for prostate cancer, using data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare, identifying 37,687 men diagnosed with prostate cancer between 2004 and 2007 who were followed until December 31, 2009. Bivariate and multivariate regression analyses were used to quantify the use of prostate-specific antigen tests, office visits, and second prostate biopsies within 2 years of diagnosis.
According to Dr. Karim Chamie, the study’s first author and an assistant professor of urology at UCLA, the results revealed that of the 3,656 men diagnosed with prostate cancer who did not undergo aggressive therapy, only 166 men (4.5%), were being monitored correctly. “This is really an important finding, because before patients and their doctors decide to pursue active surveillance as a management option for prostate cancer, both the physician and patient should agree on a follow-up schedule to closely monitor the cancer,” said Dr Chamie, who is surgical director of UCLA’s bladder cancer program and a member of the Jonsson Comprehensive Cancer Center, in a recent news release. “What was most surprising was that patients who underwent aggressive treatment for their prostate cancer were more likely to receive routine lab testing and visits with their doctor than those not receiving aggressive treatment. In other words, those likely cured through aggressive treatment were followed more closely than patients whose cancers were left untreated.”
Current measures for surveillance include additional prostate-specific antigen (PSA) tests and clinical follow-up visits as well as at least one biopsy within two years. However, as observed in other cancers, adherence to established guidelines regarding surveillance and treatment strategies continues to be problematic. According to Chamie, the finding has implications for both patients and doctors. “Many researchers have been advocating for active surveillance for men with low-risk disease,” he said. “However, this study suggests that before we advise our patients to pursue active surveillance for their prostate cancers, we should be certain that we are committed to closely monitoring the cancers with a repeat biopsy, PSA testing and physical exams.”
This is the first population-based research to compare the follow-up intensity of American men with prostate cancer who have not undergone aggressive treatment with those who opted to undergo various forms of aggressive therapy, such as surgery and radiation.
Chamie said the study did find a small but statistically significant increase in follow-up intensity with time, meaning that the more time passed, the more likely subjects were to receive the recommended tests. Going forward, the team wants to determine whether the improved compliance will plateau or accelerate over a longer time period.
Prostate cancer remains the most commonly diagnosed solid organ tumor among US men, and an estimated 220,800 new cases and 27,540 deaths are predicted for 2015. Treatment options for prostate cancer may include radical prostatectomy, external-beam radiotherapy, and brachytherapy. Active surveillance has been recommended for men who are diagnosed with low-risk prostate cancer. However, the incidence of overtreatment of low-risk disease is still prevalent. “Active surveillance is underused, and there is uncertainty regarding the quality of surveillance for patients who undergo watchful waiting or active surveillance,” the study states. “Further research is needed into qualitatively describing the contributing factors that drive decision-making recommendations as well as improved surveillance measures for patients with prostate cancer.”