For early prostate cancer, a watchful eye is just as good as treatment
In 10-year study, deaths were rare even without radiation or surgery.
BETH MOLE - 9/16/2016, 4:00 AM
In the wake of a cancer diagnosis, deciding to sit back and see how
things play out may seem like a ballsy move. But, if that diagnosis is
for early-stage prostate cancer, it might be the smart one.
In a trial of 1,643 men diagnosed with early prostate cancer, those who
actively monitored their cancer instead of immediately starting
treatment had the same minuscule risk of death in a ten-year study as
men who underwent either radiation therapy or surgery straightaway. The
finding, reported Wednesday in the New England Journal of Medicine,
suggests that it’s safe to hold off on the often slow-growing cancer
when it's caught early and only seek treatments—which can have
devastating side effects, including incontinence and impotence—if the
disease progresses.
Disease progression (i.e. the cancer grows and spreads to other parts of
the body) was more common among the 545 men randomly assigned to the
monitoring group. About half ended up getting either radiation or
surgery by the end of the ten-year study. However, they still had the
same low death rate from the cancer as the radiation and surgery
groups—about one percent. And the remaining portion that didn’t progress
and go through treatments were able to dodge needless side effects.
The authors of the study, led by researchers at the University of
Oxford, are still monitoring the patients to see if benefits of holding
off hold up over time.
Treatments definitely keep the disease from progressing, lead author
Freddie Hamdy, of Oxford, emphasized in a statement. “But we do not know
yet whether this will make a difference to them living longer or better,
and we have been unable to determine reliably which disease is lethal,
and which can be left alone.” Still, he added, what the study shows so
far is that early prostate cancer—detected by a blood test—grows “very
slowly, and very few men die of it when followed up over a period of 10
years… irrespective of the treatment assigned.”
For older men who may not live much beyond ten years regardless of
prostate cancer, the findings may be a clear enough conclusion. The men
in the study were between 50 and 69 years old, with an average age of
62. In the US, the average age at diagnosis is 66. Experts estimate that
there will be about 181,000 new prostate cancer diagnoses and 26,000
deaths in the country during 2016. And already, around half of those
diagnosed are opting for monitoring.
This active surveillance, as doctors call it, requires regular clinic
visits for physical exams, biopsies, and blood tests for
prostate-specific antigen (PSA) levels, rising levels of which can
indicate worsening disease.
The other options are either radiation or surgery. In the study,
researchers noted that those who were randomly assigned to surgery were
the most likely to suffer from lingering impotence and incontinence.
Those given radiation therapy, which was coupled with a hormone therapy
that starves cancer cells, had lingering bowel problems and some
lingering problems with impotence.
While previous research has hinted that prostate cancer may not be a
life sentence warranting immediate treatment, the new study is the first
to compare monitoring with the two modern treatments.
New England Journal of Medicine, 2016. DOI: 10.1056/NEJMoa1606220 (About
DOIs).
