Many men with prostate cancer can delay treatment in favor of “active surveillance,” a decades-long study finds. Because prostate cancer is relatively mild, and overtreatment can also destroy health, that is, too much is too much.
Removal of the prostate gland or exposure to high-energy radiation can lead to long-term side effects such as urine leakage, erectile dysfunction, and other urinary, bowel, and sexual problems.
“The good news is that if you’ve been diagnosed with prostate cancer, don’t panic and take the time to decide what to do about it,” said study lead author Dr Freddie Hamdy, professor of surgery and urology at the University of Oxford told CNN. Crucially, this recommendation only applies to men with low- or intermediate-risk prostate cancer—high-risk men still need prompt treatment.
The new study was published March 11 in the journalnew england journal of medicine(New England Journal of Medicine), which included more than 1,600 British men with prostate cancer, aged 50 to 69 when the study began in 1999. The patients were randomly divided into three groups to receive different treatments: one third had their prostate removed, one third received radiation and short-term hormone-blocking therapy, and one third received surveillance only.
In this study, “active monitoring” meant regularly measuring levels of specific proteins in patients’ blood. Levels of this prostate-specific antigen (PSA) protein increase as prostate cancer progresses. Dr. Oliver Sartor, medical director of the Tulane Cancer Center, wrote in an opinion piece that today’s “active surveillance” may also involve additional tests, such as prostate MRI. Scanning and genetic testing etc.
The researchers followed each participant for 11 to 21 years after diagnosis and found that all patients had a low risk of death, regardless of the treatment they received. Overall, 45 participants (2.7%) died from prostate cancer. This included 12 (2.2%) in the surgery group; 16 (2.9%) in the radiation group; and 17 (3.1%) in the surveillance group; small differences between them were not statistically significant.
During about 15 years of follow-up, about 330 men in the surveillance group, or 60 percent, eventually underwent surgery or radiation therapy. But waiting to receive treatment did not appear to affect their risk of death. In addition, 133 people in the surveillance group who never underwent surgery, radiation, or hormone-blocking treatment survived.
Fifteen years after diagnosis, cancer metastasized or spread in 9.4% of the surveillance group, 4.7% of the surgery group, and 5% of the radiation group. However, Dr. Stacy Loeb, a prostate cancer specialist at NYU Langone Health who was not involved in the study, told The Associated Press: “We now have more ways to prevent cancer from spreading. It was discovered before.” It is important to note that “the vast majority of trial patients were low-risk or favorable intermediate-risk and would be considered appropriate candidates for surveillance today,” with only a small fraction of study participants in the high-risk category requiring Treat immediately, Sato wrote in his review.
In general, high-risk prostate cancer diagnoses account for only 15 percent of cases — so most cases of prostate cancer are low- to intermediate-risk, according to CNN. For low-risk patients, the potential risks and benefits of surgery and radiation should be carefully weighed, as “overtreatment can do more harm than good,” the study authors concluded. ◇
Editor in charge: Li Ming
