Low-risk prostate cancer patients may have good clinical outcomes by avoiding immediate treatment

March 16th, 2009 - 4:32 pm ICT by ANI  

Washington, March 16 (ANI): A new study suggests that opting not to receive immediate treatment may be safe for men newly diagnosed with prostate cancer, and who are at minimal risk of cancer progression, if they are closely monitored.
Dr. Scott Eggener, assistant professor of surgery at the University of Chicago Medical Center, says that the study addresses an important question as to when to actively treat versus when to observe and closely monitor.
Radiation therapy and surgery are effective treatments, but they can be associated with serious long-term side effects like incontinence and erectile dysfunction.
The new study has shown that two separate biopsies are needed to determine optimal selection of patients for active surveillance, also known as “watchful waiting”, when patients decide not to undergo immediate treatment.
Dr. Eggener notes that there are no widely-accepted recommendations on which patients are appropriate candidates for active surveillance or when to perform second or “restaging” biopsies.
He says that a restaging biopsy provides doctors with additional information regarding the cancer, and is the best way to ensure the short-term success of active surveillance.
“When or if to treat men with low-risk prostate cancer has always been a challenging question that faces patients and urologists,” the researcher says.
“Some men may be rushing into treatment that won”t necessarily benefit them, prevent problems, or prolong life. Close observation in certain patients may provide and maintain quality of life without increasing the chances of the cancer spreading,” he adds.
According to Dr. Eggener, it is important for patients to undergo a restaging biopsy following the initial diagnostic biopsy, before active surveillance is elected.
The study conducted between 1991 and 2007 involved 262 men from four hospitals in the U.S. and Canada.
Of that initial pool electing surveillance of their cancer, 43 patients eventually chose treatment or had evidence of cancer progression prompting recommendation of treatment by their physician.
Following delayed treatment, all but one were cured of their cancer.
The remaining 219 patients remained on active surveillance without evidence of metastases.
“Active surveillance with delayed treatment, if necessary, for select patients appears to be safe and associated with a low risk of metastatic spread,” the study concludes.
Unlike many past studies on active surveillance that used data before PSA tests were widely available, this multi-centre study is based on patients who were screened with the PSA blood test, a widely used cancer-screening tool that predicts a man’’s chances of having prostate cancer.
“Active surveillance is not a total disregard for patients with prostate cancer. Instead, it identifies men unlikely to be affected by their cancer and encourages frequent monitoring, and then starting therapy at a later appropriate time if needed. Cure rates appear to be identical when these men choose immediate treatment or delayed treatment when prompted by new information about their condition,” Eggener says.
The study has been published in the Journal of Urology. (ANI)

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