The Changing Course of Prostate Cancer Treatment

Active surveillance for prostate cancer treatment spiked in recent years

(RxWiki News) Treating prostate cancer is a balancing act — not too much treatment, but not too little. And it looks as though doctors may be getting better at balancing.

A new study found that low-risk prostate cancer was less likely to be overtreated than in years past.

“The magnitude and speed of the changes suggest a genuine change in the management of patients with prostate cancer in the United States, which could accelerate as more clinicians begin to participate in registry efforts. Given that overtreatment of low-risk disease is a major driver of arguments against prostate cancer screening efforts, these observations may help inform a renewed discussion regarding early detection policy in the United States,” wrote the authors of this study.

Study authors Matthew R. Cooperberg, MD, and Peter R. Carroll, MD, of the University of California at San Francisco, assessed the management of prostate cancer in community treatment programs.

Prostate cancer is typically very slow-growing. It is also common in older men.

In most cases, prostate cancer tumors are found early, when they are small and have not spread, according to the National Cancer Institute.

Treatment options include watchful waiting — also called active surveillance — which is often possible because the tumors tend to grow so slowly. In active surveillance, patients are carefully monitored for changes that suggest more aggressive treatment is required.

Other treatment options for low-risk prostate cancer include surgery and radiation therapy. These are not the preferred options because of side effects and treatment risks.

Side effects from surgery include bleeding, infection and anesthetic complications. Radiation therapy can cause damage to healthy tissue and skin burns.

Although active surveillance is commonly practiced in academic centers, Drs. Cooperberg and Carroll said it has not been well-utilized in community treatment in the past.

These researchers collected data from a national cancer registry that included 45 urology practices in 28 states. Drs. Cooperberg and Carroll analyzed data on 10,472 men with an average age of 66.

Men with low-risk tumors were increasingly being treated with active surveillance, these researchers found. Active surveillance use increased from around 7 to 14 percent of low-risk prostate cancer patients through 2009 to 40 percent in 2013.

Because treatment carries risks and side effects, active surveillance can be a good choice, Drs. Cooperberg and Carroll noted. In very slow-growing, low-risk tumors, many men can live a long time without having any problems from the cancer.

This study was published July 7 in JAMA.

TAP Pharmaceutical Products, Inc., funded this study until 2007. Current funding was supplied by the US Department of Defense and the University of California Department of Urology.

Dr. Cooperberg received grants or personal fees from Myriad Genetics, Genomic Health and GenomeDx, Dendreon, Astellas and Bayer. These companies make diagnostic tests or drugs used in cancer diagnosis and treatment.

Review Date: 
July 7, 2015