Surveillance, Not Action, for Prostate Cancer?

Prostate cancers do not need immediate treatment panel advises

(RxWiki News) Prostate cancer is the second most common cancer in men next to skin cancer. Interestingly, though, not all men are treated for this disease immediately after diagnosis. And a panel advises this is as it should be.

Men with localized (hasn't spread), low-risk prostate cancer should be closely monitored instead of undergoing immediate treatment.

The process of this so-called "active surveillance" needs to be carefully defined so management strategies can be standardized to optimize patient outcomes. This is the advice of an independent panel convened by the National Institutes of Health.

"Your prostate cancer may need to be closely monitored instead of immediately treated."

Conference panel chairperson, Dr. Patricia A. Ganz said in the news release announcing these findings,  “It’s clear that many men would benefit from delaying treatment, but there is no consensus on what constitutes observational strategies and what criteria should be used to determine when treatment might ultimately be needed among closely-monitored men,” said Dr. Ganz,  who is director of the Division of Cancer Prevention and Control Research at the Jonsson Comprehensive Cancer Center at the University of California in Los Angeles.

In 2011, an estimated 240,000 men will be diagnosed with prostate cancer in the United States. More than half of these cancers are not considered aggressive or life-threatening at the time of diagnosis.

Yet, roughly 90 percent of men undergo immediate treatment which may include surgery, radiation and/or hormone therapy. 

These therapies have serious and often long-term side effects ranging from urinary control problems to sexual dysfunction. And the benefits of these therapies aren't always clear. So determining the best way to manage various types of prostate cancer is urgently needed to improve survival while minimizing adverse side effects.

Currently, physicians have two approaches to treating localized prostate cancer:

  • Observation without intent to cure is watchful waiting, with treatment offered as symptoms develop
  • Observation with intent to cure, involves active surveillance including regular PSA (prostate-specific antigen) blood tests, digital rectal exams and repeat biopsies as needed, with treatment beginning if and when the cancer progresses.

The panel found that the medical community has reached a consensus for defining low-risk prostate cancer:

  • PSA levels of less than 10 ng/mL
  • Gleason score of 6 or less

Based on these parameters, the panel estimates that more than 100,000 men are diagnosed with low-risk prostate cancer every year. What's missing, though, are protocols for managing active monitoring, such that it's difficult to evaluate and compare research findings.

Dr. Ganz said,  "We need to standardize definitions, group patients by their risks, and conduct additional research to determine the best protocols for managing low-risk disease.”

Because the outlook for PSA-detected, low-risk prostate cancer is so optimistic, the panel also recommended that the disease be described differently, eliminating the term "cancer" in the definition.

The panel also said that clinicians need to work closely with men and management decisions should be highly individualized.

This decision making needs to take into consideration other influential factors including family members' views, lifestyle, personal philosophy and cancer experiences of friends and family. In short, consideration needs to be given to psychological, social and cultural factors, as well as biological.

Future research should involve multi-site clinical research studies and the establishment of databases that collect data on clinical and patient-reported outcomes, the panel recommends.

This panel was made up of 14 members from a variety of fields including cancer prevention and control, urology, pathology, epidemiology, genetics, bioethics, economics, health services research, shared decision-making, transplantation, health communication and community engagement.

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Review Date: 
December 8, 2011