Men diagnosed with localized prostate cancer who want to avoid immediate surgery or radiation can safely choose active disease surveillance as a treatment option. study published Saturday in the New England Journal of Medicine.
The researchers in the study determined that most men should not panic or rush into treatment decisions after diagnosis, as cancer death rates 15 years later were relatively low, regardless of treatment approach.
A study started in the UK in 1999 included 2,664 men aged 50 to 69 who were diagnosed with localized prostate cancer. Of these men, 1643 were included in the study, which examined three different treatments: surgical removal of tumors (553), radiation therapy (545) and active surveillance (545).
After a median range of 15 years, the researchers compared participants with death from prostate cancer and death from other causes. The study notes that more than a third of men were at intermediate or high risk at diagnosis.
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This microscopic image from 1974, provided by the Centers for Disease Control and Prevention, shows cellular changes suggestive of adenocarcinoma of the prostate. (Dr. Edwin P. Ewing, Jr./CDC via AP)
Of the 1610 patients followed, 45 were men died of prostate cancer – 17 people in the active observation group, 12 people who underwent surgery to remove the tumor, and 16 people who underwent radiation therapy.
Death not related to prostate cancer occurred in 356 men, with the same number in all three treatment groups.
At the end of follow-up, 133 men in the active follow-up group were alive without any treatment for prostate cancer.
The study found that there was no difference in the impact on cancer mortality based on baseline PSA levels, tumor stage or grade, or risk stratification scores. After a 10-year analysis, there were also no treatment complications reported.
X-rays of a patient with prostate cancer (iStock)
At 15 years, the cancer had spread in 9.4% in the active observation group, 4.7% in the surgical group, and 5% in the radiotherapy group.
Lead author Dr. Freddie Hamdy of the University of Oxford wrote that the researchers saw a difference in the spread of cancer after 10 years and expected it to affect survival after 15 years, but this was not the case. He added that spread alone does not predict death from prostate cancer.
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Dr. Stacey Loeb, a prostate cancer specialist at NYU Langone Health, who was not involved in the study, told The Associated Press that the results are encouraging for men who want to avoid the problems with sex and urinary incontinence that can result from treatment.
“Now we have more ways to help understand that the disease is progressing before it spreads,” Loeb said. In the US, about 60% of low-risk patients opt for monitoring, now called active surveillance.
Hamdi said “new and interesting” results allow most men to “thoroughly consider the possible benefits and harms caused by treatment options”, although he pointed out that a few high-risk or advanced disease patients do need urgent treatment.
The Tulane Cancer Center in New Orleans will be the first center in the United States to treat prostate cancer with a new experimental drug that is already being tested in Europe. The drug Alfaradin, used to treat advanced diagnostics, destroys cancer cells that have spread to the bones (highlighted in the image), while leaving healthy bone marrow intact. (Tulane Cancer Center)
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The results were also presented at the European Association of Urology conference in Milan, Italy.
The study was funded by the UK’s National Institute for Health and Care Research.
The Associated Press contributed to this report.