Patients with low risk prostate cancer on active surveillance for three years experienced similar health related quality of life as men without prostate cancer, both clinically and psychologically, according to the study “Prospective Quality of Life in Men Choosing Active Surveillance Compared to Those Biopsied but not Diagnosed with Prostate Cancer,” published in The Journal of Urology .
The concept of active surveillance (AS), or watchful waiting, has increasingly emerged in recent years as a viable option for men with low risk prostate cancer who decide not to undergo immediate surgery or radiation therapy. During AS, prostate cancer is carefully monitored for signs of progression. A PSA blood test and digital rectal exam (DRE) are usually administered periodically, along with a repeat biopsy of the prostate at one year and then at specific intervals thereafter. If symptoms develop, or if tests indicate cancer growth, treatment might be warranted.
The study investigated the impact of AS on health related quality of life (HRQoL) in men that opt to wait and see, rather than treat the cancer right away with drugs or surgery.
“To our knowledge this is the first report of HRQoL outcomes of men on AS for prostate cancer compared to men without prostate cancer in a prospective, multi-institutional study,” study author Dr. Christopher R. Porter said in a news release. “The potential clinical impact of these results is significant and will allow clinicians to counsel patients effectively in regard to the potential HRQoL outcomes associated with AS.”
Management of low risk prostate cancer with AS appears feasible and safe, but most men in the U.S. with low risk disease still undergo definitive therapies such as radical prostatectomy, which carry the potential for urinary, bowel, and sexual dysfunction. All of the impact is avoidable, or at least postponed, with management under AS.
The new study followed men in the Center for Prostate Disease Research Multicenter National Database who underwent prostate needle biopsy from 2007 to 2014. HRQoL was measured at biopsy baseline and every year for up to 3 years using two questionnaires; one that evaluated prostate cancer related outcomes, and a second that focused on general health.
Of the 1,204 men included in the study, 420 had a negative prostate needle biopsy (noncancer comparison group). The 411 men with low risk prostate cancer (clinical stage T1-T2a, biopsy Gleason score 6 or less, and prostate specific antigen less than 10 ng/ml 89 low risk prostate cancer), were on active AS.
The results showed no differences between the two groups in adjusted HRQoL score trends over time.
“Our results suggest that for at least three years, men selecting AS do not experience a substantial psychological burden or clinically significant problems due to untreated disease. This study provides important data that can be used to inform comparable patients when considering management options for low risk prostate cancer,” Porter said.
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