Intermediate-Risk Prostate Cancer: A New Management Method?

Active surveillance may manage intermediate-risk prostate cancer effectively

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) If you have prostate cancer, you may be seeing a lot more of your doctor. That's because this cancer is often managed with frequent checkups rather than aggressive treatment in low-risk cases. And this may be the best option for some intermediate-risk cases, too.

Active surveillance — not aggressive treatment — might be the best choice for men with intermediate-risk prostate cancer. A new study found that, in older men with intermediate-risk prostate cancer and an at least 10-year life expectancy, keeping an eye on things may be the best choice.

Prostate cancer is graded according to risk. Doctors assess risk based on several factors: how big the tumor is, what type of cancer it is and whether it has spread, among others.

Patients with low-risk prostate cancer, for instance, may have a slow-growing tumor so small the doctor can't feel it in the physical exam. Patients with intermediate risk are more likely to have a larger or different type of tumor.

Active surveillance is already accepted as a method for managing low-risk prostate cancer. This new study found that, in men with intermediate-risk prostate cancer, active surveillance may be the best choice for an initial approach rather than more aggressive treatment.

“Our results provide evidence to support active surveillance as an initial approach for men with favorable intermediate-risk prostate cancer,” wrote the authors of this study.

Alexander Kutikov, MD, an oncologist with Fox Chase Cancer Center in Philadelphia, told dailyRx News that while this study supported the findings of past research, its eight-year follow-up time wasn't likely long enough to see the true differences between active surveillance and more aggressive treatments. Still, Dr. Kutikov said, "The active surveillance landscape is rapidly changing."

With new and improved technologies, "use of active surveillance will undoubtedly grow and will be expanded to more and more patients," Dr. Kutikov said.

Ann C. Raldow, MD, of Brigham and Women’s Hospital in Boston, led this study of more than 5,500 men with prostate cancer treated between 1997 and 2013. These researchers compared men with intermediate-risk and low-risk prostate cancer who had had brachytherapy — small radiation pellets placed in the prostate to fight the cancer.

Dr. Raldow and team looked at the cause of death for the more than 600 men in this study who died. Only 34 of those men actually died of prostate cancer.

There was no difference in the risk of death from prostate cancer in men who had intermediate-risk prostate cancer and men who had low-risk prostate cancer.

The prostate gland is located in the male pelvis. Cancer of the prostate is the second most common cancer in men, but it is often slow-growing, according to the American Cancer Society.

Overtreatment of prostate cancer carries risks, such as medication or radiation side effects. Watchful waiting and active surveillance are two methods of preventing overtreatment.

In watchful waiting, patients are followed, but the cancer isn’t treated unless the patient develops symptoms or there is a sign the cancer has spread.

Active surveillance uses various monitoring tools, such as prostate-specific antigen blood tests, digital rectal exams and ultrasounds at regular intervals, to check for cancer growth. Active surveillance still leaves the door open for treatment if the cancer progresses.

“Despite potential study limitations, we found that men with low-risk prostate cancer and favorable intermediate-risk prostate cancer have similar and very low estimates of [dying from prostate cancer or another cause] during the first decade following brachytherapy,” Dr. Raldow and team wrote.

Still, in an editorial about this study, urologist Fred Saad, MD, of the University of Montreal in Canada, said doctors should still be cautious when opting for active surveillance. Some past research, he wrote, has found that patients may have worse outcomes with this method.

“Although I am a urologist who has been practicing active surveillance for most of my low-risk patients for many years, I suggest that we continue to be very cautious, and extremely selective, in offering active surveillance to patients with any features of intermediate-risk prostate cancer.”

The study and editorial were published Feb. 19 in JAMA Oncology.

Dr. Raldow and team disclosed no funding sources or conflicts of interest.

Review Date: 
February 18, 2015
Last Updated:
February 20, 2015