Instead of immediate radiation therapy or surgery, a significant proportion of American men with low-risk prostate cancer could choose “active surveillance” as a safe, viable option to monitor their disease.
That finding comes from a recent analysis of Sweden’s National Prostate Cancer Register (NPCR) showing that active surveillance has become the dominant management strategy for men with low-risk prostate cancer in Sweden, which could serve as a benchmark to compare its use around the world.
The study, “Uptake of Active Surveillance for Very-Low-Risk Prostate Cancer in Sweden,” published in the Journal of the American Medical Association (JAMA) Oncology, compared the Swedish data to models from the United States and showed that greater use of active surveillance will increase the cost-effectiveness of prostate cancer screening.
Active surveillance is a monitoring option that allows patients to screen for any signs of tumor growth before removal or therapy is considered. Active surveillance is accomplished through blood tests, physical exams and periodic biopsies of prostate tissue. The study’s authors say that the move to active surveillance also averts the risk of sexual dysfunction, as well as bowel and bladder problems that are common when choosing traditional therapies. In addition, researchers found that when faced with the options, most men already chose to monitor their prostate cancer.
The study found that between 2009 and 2014 the use of active surveillance increased in men of all ages from 57% to 91% for very-low-risk prostate cancer, and from 40% to 74% for low-risk prostate cancer. Meanwhile, the number of men who chose just to wait with no further testing and postpone therapy, a passive practice called “watchful waiting,” dropped by more than half.
“The main conclusion here is that if the majority of men in Sweden have adopted this management strategy for very low- to low-risk prostate cancer, then more American men might choose this option if it were presented to them,” Stacy Loeb, MD, MSc, lead study investigator and urologist, said in a press release.
Loeb is an assistant professor in the urology and population health departments at NYU Langone, one of the organizations that funded the study. Loeb says that while increasing numbers of men in the U.S. diagnosed with early-stage prostate cancer are choosing active surveillance, they still account for less than 50% of those who are given the option.
A large longitudinal study showed recently that 10 years after diagnosis there was no difference in death rates among those who chose to receive active surveillance compared to those who chose immediate treatment. Meanwhile, Loeb said, the risks of side effects among men who undergo radiation therapy can be greater, even though the pattern is not confirmed.
“Our findings should encourage physicians and cancer care professionals in the United States to offer such close supervision and monitoring to their patients with low-risk disease,” Loeb added. “[More Americans choosing active surveillance] could go a long way toward reducing the harms of screening by minimizing over-treatment of non-aggressive prostate cancer.”
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