More Prostate Cancer Patients Are Choosing Active Surveillance Over Surgery and Radiation

Prostate cancer often grows slowly, so immediate treatment may not be necessary, if treatment ends up being necessary at all. This leads many patients to opt for active surveillance, which involves a close monitoring of the cancer to ensure it’s not progressing. It can be a good option for older men, those with serious health problems, or those with low-risk prostate cancer. A new study finds that more patients are opting for it, too.

Researchers at Vanderbilt University Medical Center (VUMC) recently looked at the rates of active surveillance among American prostate cancer patients. Their findings, published in JAMA Internal Medicine, showed that in 2018, about 60% of low-risk patients were choosing this option over surgery or radiation, up from 16% in 2010, while over the same period, the rate rose from 8% to 22% for patients with favorable intermediate-risk cancers.

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The researchers say this may be a good thing.

Dr. Bashir Al Hussein Al Awamlh, lead author and second-year Urologic Oncology fellow at VUMC, explains, “The study’s findings are encouraging because it shows an increase in the proportion of men who benefit from active surveillance over time.

“Our findings suggest that patients and physicians are increasingly becoming more comfortable with observing a subset of cancers with low-risk features, extending the benefits of surveillance to more men. However, there remains room for improvement in active surveillance uptake to reach similar rates as in some countries in Europe or Australia. Particularly in light of recent data demonstrating the safety of active surveillance in low-risk cancers.”

To gather their data, the team used the Surveillance, Epidemiology, and End Results (SEER) “Prostate with Watchful Waiting database”, focusing on men over 40 with low- and favorable intermediate-risk prostate adenocarcinoma.

While the researchers found the rate of men who chose active surveillance rose between 2010 and 2018 in both groups, there were still some disparities based on race and ethnicity, income, and location. This included the finding that Hispanic patients, those with lower incomes, and those living in rural areas were less apt to choose or even be offered active surveillance.

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However, the overall trend of more men opting for this approach may lead to fewer adverse treatment side effects, while having little impact on disease risk.

Dr. Jonathan Shoaq, senior author and associate professor of urology at University Hospitals Seidman Cancer Center in Cleveland, says, “These data show that a diagnosis of prostate cancer no longer means a patient will undergo treatment. This further strengthens what are already compelling arguments that the benefits of screening for prostate cancer with PSA far outweigh the harms. We now can, and do, avoid treating cancers that we believe will behave indolently.”

According to the American Cancer Society, active surveillance typically includes a doctor visit with a blood test every six months and a digital rectal exam at least once a year. There may also be periodic prostate biopsies and imaging tests. If test results change, treatment options are discussed.

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