More men with low-risk prostate cancer choosing active surveillance

While many men with low-risk prostate cancer have been known to undergo immediate surgery or radiation treatment, a new study published in JAMA found that more men are choosing active surveillance.

In 2010, the National Comprehensive Cancer Network (NCCN) established national guidelines advocating that men with low-risk prostate cancer strongly consider taking an active surveillance approach over immediate treatments such as surgery or radiotherapy.  

Researchers led by Brandon Mahal, MD, from the department of radiation oncology at the Dana-Farber Cancer Institute, identified a total of 164,000 men diagnosed with localized prostate cancer between 2010 and 2015.  

Using data from the Surveillance, Epidemiology, and End Results (SEER) Prostate Active Surveillance/Watchful Waiting database, the researchers identified from these patients who used a watchful waiting or active surveillance approach between 2010 to 2015.  

A watchful waiting approach involves the patient reporting symptoms such as changes in urinary habits, pain, or irritation or bone pain that could reflect metastatic progression. Active surveillance, meanwhile, involves periodic follow-up tests for PSA levels, repeat biopsies and exams by a physician every six to 12 months.  

The use of active surveillance by men with low-risk prostate cancer increased from 14.5 percent to 42.1 percent, according to Mahal et al. During the same time period, radical prostatectomy procedures (the removal of the prostate gland) decreased from 47.4 percent to 31.3 percent and the use of radiotherapy for low-risk prostate cancer decreased from 38 percent to 26.6 percent.  

“This encouraging finding suggests that clinicians are better adhering to current recommendations and guidelines for men with low-risk prostate cancer, as the use of active surveillance in appropriately selected men will reduce rates of overtreatment,” Howard Soule, PhD, executive vice president and chief science officer of the Prostate Cancer Foundation, said in a prepared statement.  

In addition to their findings, the researchers were surprised to find changes in treatment for high-risk prostate cancer patients from 2010 to 2015. During that same time period, use of radical prostatectomy increased from 38 percent to 42.8 percent while radiotherapy decreased from 60.1 percent to 55 percent. 

“This shift in management patterns away from radiation therapy and toward more radical prostatectomy is not supported by any recent high-level studies,” Mahal said in a statement. “This finding is provocative and may be a focal point of debate.”