More American men with early-stage prostate cancer could opt out of immediate treatment

October 20, 2016

A new report on Swedish men with non-aggressive prostate cancer suggests that a lot more American men could safely choose to monitor their disease instead of seeking immediate radiation treatment or surgery.

Published in the Journal of the American Medical Association (JAMA) Oncology online Oct. 20, the report shows that well over half of 32,518 men in Sweden diagnosed with prostate cancers least likely to spread chose monitoring during a recent, five-year period over immediate treatment.

Led by researchers at NYU Langone Medical Center and its Perlmutter Cancer Center, an international team concluded that men are likely to choose monitoring once presented with the choice.

Called active surveillance, the monitoring option relies on regular blood tests, physical exams, and the periodic biopsy, or sampling, of prostate tissue to screen for any signs of a tumor's growth before therapy is considered. The move to active surveillance, say the study authors, averts the risk of sexual dysfunction, as well as bowel and bladder problems that frequently accompany traditional therapies.

"The main conclusion here is that if the majority of men in Sweden have adopted this management strategy for very low- to , then more American men might choose this option if it were presented to them," says lead study investigator and urologist Stacy Loeb, MD, MSc.

Among the study's key findings was that from 2009 to 2014 the number of Swedish men with very low-risk cancer choosing active surveillance increased from 57 percent to 91 percent, and men with low-risk cancer choosing this option rose from 40 percent to 74 percent. Meanwhile, the authors report, the number of men in both groups who chose to simply wait, do no further testing, and postpone therapy unless symptoms develop—a passive practice called watchful waiting—dropped by more than half.

For the study, researchers analyzed data from Sweden's National Prostate Cancer Register, one of the few such national databases in the world (and for which nothing comparable exists in North America).

Loeb, an assistant professor in the urology and population health departments at NYU Langone, and a member of Perlmutter, says that while increasing numbers of American men diagnosed with early-stage disease are choosing active surveillance, they still account for less than half of those for whom it is an option.

"Our findings should encourage physicians and cancer care professionals in the United States to offer such close supervision and monitoring to their patients with low-risk disease," says Loeb. More American men opting for active surveillance, she adds, "could go a long way toward reducing the harms of screening by minimizing overtreatment of non-aggressive prostate cancer."

Loeb says recent studies have suggested that some men with early-stage disease who opted for treatment later regretted it because of lingering problems, such as incontinence and impotence.

A large study also recently showed no difference in death rates a decade after diagnosis between those who chose and those who chose immediate treatment, Loeb says. Meanwhile, there is a greater risk of side effects among men undergoing therapy. She cautions, however, that this pattern has not been confirmed for the Swedish men in the current study.

The U.S. National Cancer Institute estimates that 26,000 American men will die from the disease in 2016, with 181,000 getting diagnosed, most in its earliest stages.

Explore further: Men who forgo aggressive treatment for prostate cancer don't receive appropriate monitoring

Related Stories

Recommended for you

Ancient stress response provides clues to cancer resistance

April 25, 2017

Cancer is often able to craftily outwit the best techniques modern medicine has developed to treat it. In an attempt to understand and combat cancer's vaunted prowess, an unusual collaboration between physicists and a leading ...

Studying a catalyst for blood cancers

April 25, 2017

Imagine this scenario on a highway: A driver starts to make a sudden lane change but realizes his mistake and quickly veers back, too late. Other motorists have already reacted and, in some cases, collide. Meanwhile, the ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.