Active Surveillance Better than Surgery or Radiation Therapy for Men at Low Prostate Cancer Risk

Active Surveillance Better than Surgery or Radiation Therapy for Men at Low Prostate Cancer Risk

Men with localized prostate cancer may want to consider active surveillance over surgery or radiation therapy, suggests a study by Tennessee’s Vanderbilt University Medical Center .

The study, “Association Between Radiation Therapy, Surgery, or Observation for Localized Prostate Cancer and Patient-Reported Outcomes After 3 Years,” appeared in the Journal of the American Medical Association. It compared the outcomes and adverse effects of traditional prostate cancer treatments, such as radical prostatectomy and external beam radiation therapy (EBRT), against active surveillance.

The population-based study involved 2,550 men diagnosed with localized prostate cancer who had been treated with radical prostatectomy, EBRT or active surveillance, and were followed for three years.

Researchers found that erectile dysfunction and urinary incontinence were more common in men treated with surgery than with either radiation therapy or active surveillance. Interestingly, patients treated surgically had fewer urinary irritative symptoms, such as weak urine stream or urinary frequency, than those put under active surveillance.

Three-year survival from prostate cancer was exceeded 99 percent regardless of treatment, and none of the options prevented the men from performing daily activities or having enough energy. According to researchers, this suggests that active surveillance may be a viable alternative to either surgery or radiation therapy given the potentially negative side effects of conventional treatment.

“Patients who were treated with surgery or radiation had side effects while those who were managed with active surveillance, for the most part, did quite well,” Daniel Barocas, MD, MPH, associate professor of urologic surgery at Vanderbilt, said in a press release. “It is best to avoid treatment if you have a prostate cancer that is safe to observe. This is why most doctors recommend ‘active surveillance’ for low-risk cancers.”

While active surveillance did not lead to worse outcomes after three years, the researchers cautioned that prostate cancer tends to be slow-growing and that further studies, up to 10 years in length, are needed in order to determine differences in mortality.

“This study shows that, despite technological advances in the treatment of prostate cancer, both surgery and radiation still have negative effect on quality of life,” said co-author David Penson, MD, MPH, and urology professors Paul V. Hamilton, MD, and Virginia E. Howd.

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James Frederick is a practicing Physician Associate (PA-C, MMSc) who studied at Yale University. He also has a bachelor’s degree in creative writing and English Literature from the University of Colorado. He specializes in writing medical content that is approachable, readable and enjoyable. He has a strong background in research, physiology, pharmacotherapy, emergency medicine and critical care medicine. In his free time, he enjoys spending time camping and traveling with his wife and dog.
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3 comments

  1. Lawrence Glickman says:

    Once again I have to voice my opposition to this study and the point of view that promotes “watchful waiting”. This theory is based on percentages and 5 year or less survival rates. It is also based on quality of life issues based on old fashioned surgery and radiation. The reality is that the cancer is not going away by “watching it”. Can any Doctor promise that there will not be metastases during the “watchful waiting” period? Obviously not. In addition the small lesions discovered during this time period are excellent candidates for the new “Focal” therapies such as limited cryo, Hifu, and the new Toookad system that has passed phase 3 FDA testing at Sloan Kettering. This method developed in Israel is on the verge of approval in Europe and the USA and is available in Mexico and does not use radiation, surgery or destructive chemotherapy. Gambling that there will be no metastases during a waiting period is today an unnecessary risk. Often patients are not informed of these new therapies. to conclude I am not a Doctor but an independent researcher to honor the death of my father over a tragic 13 year period with prostate cancer and the recovery of my brother by aggressive early treatment. He is 83 and plays tennis daily!

  2. Joe Zurawski says:

    One very important item studies like this seem to ignore is the fact that while the PCa is under surveillance it is growing. Consequently when the time comes to undergo treatment it is significantly more difficult with lesser chances of success and greater chances of complications and side effects.

  3. ralph Rousseau says:

    at 80 (in June) I ‘passed’ all tests -“CLEAR” – MRI-CT-Biopsy-PetScans (2 types)- last 3 years but numbers keep climbing- (now 33.)No symptions – except frequent(3-4)night urinations – which I’ve done for over 25 years – Whats What??

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