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Wait-and-see approach could avoid unnecessary prostate cancer treatment
Men with prostate cancer that has a low risk of of getting worse could avoid having surgery or treatment thanks to a wait-and-see approach called ‘active surveillance’, a new study has found.
BMJ Group News
What do we know already?
Only men have a prostate gland. If you have prostate cancer, some of the cells in your prostate have started to grow out of control, invading and destroying healthy cells. The disease generally occurs in older men, and you are more likely to be affected the older you get.
Prostate cancer can be treated with surgery to remove the prostate, or with treatment using radiotherapy or hormones. But if you have prostate cancer it’s possible to live without symptoms for many years, and you may never have any symptoms that bother you. So it’s possible that many men with prostate cancer might never need to have treatment. But we need good-quality studies to know if choosing not to have treatment affects how likely you are to have symptoms or health problems caused by prostate cancer.
The new study of men in Sweden looked at an approach called active surveillance. This is when doctors regularly check your cancer with tests and investigations, but wait and see whether your cancer grows or starts to cause problems, rather than treating it immediately. The researchers looked at whether active surveillance could reduce the number of men who have treatment they don’t need - what doctors call ‘over-treatment’. Reducing over-treatment is important to avoid unnecessary surgery, or treatment with drugs and radiotherapy that can have unpleasant side effects.
The study looked at 439 men with an average age of 65, who were diagnosed with prostate cancer that doctors thought wasn’t likely to get worse quickly. The men were tested every few months to see if their cancer showed any signs of getting worse. If that happened, they then had the option of having surgery or starting other treatments. The men were followed up in this way for an average of six years.
What does the new study say?
During the study 162 of the 439 men stopped having active surveillance, usually because their cancer showed signs of worsening. They then went on to have either surgery, radiotherapy, or hormone treatment. This means that 277 of the 439 men - or 63 in 100 men - did not need to have treatment for an average of six years after they were diagnosed with prostate cancer.
On average it was eight years before men who had active surveillance needed any further treatment.
Sixty of the 439 men died during the study period, but mostly from other causes - only one man died from prostate cancer. The researchers concluded that active surveillance seems to be a safe way of monitoring prostate cancer in men whose disease is not likely to get worse quickly.
How reliable is the research?
This seems to have been a well-conducted study, but the average follow-up of only six years is still quite short. A longer study would be needed to show that active surveillance is a safe strategy in the longer term.
What does this mean for me?
If you are diagnosed with prostate cancer, you should have tests to show how likely your disease is to progress quickly. You can talk to your doctor about your options. If your disease is not likely to get worse in the short term, it might be reassuring to know that you may not need to have radical treatment such as surgery - at least not straight away.