Home Men Health Most Men With Low-Risk Prostate Cancers Now Forgo Immediate Surgery

Most Men With Low-Risk Prostate Cancers Now Forgo Immediate Surgery

Most Men With Low-Risk Prostate Cancers Now Forgo Immediate Surgery

TUESDAY, April 4, 2023 (HealthDay News) — Over the past decade, increasingly more Americans with early-stage prostate cancer have postpone radiation and surgery, the usual treatment options, latest research indicates.

As an alternative, many U.S. men with low- or intermediate-risk prostate cancer have embraced “energetic surveillance,” by which their disease is rigorously monitored for any sign of progression that may eventually require intervention.

In the brand new study, the investigators found that since 2010 the variety of low-risk prostate cancer patients who’ve chosen energetic surveillance over immediate treatment has shot up from 16% to roughly 60%.

In the identical timeframe, surveillance has also risen amongst intermediate-risk patients, jumping from about 8% to 22%.

The trend appears to reflect the proven fact that “skilled societies have advocated for energetic surveillance of low-risk cancers for over a decade now,” said study lead writer Dr. Bashir Al Hussein Al Awamlh, a urologic oncology fellow at Vanderbilt University Medical Center in Nashville, Tenn.

“The speculation behind energetic surveillance is that some cancers have a low potential to spread outside of the prostate and are non-lethal,” Al Hussein Al Awamlh noted. In such cases, immediate treatment shouldn’t be obligatory.

Studies indicate that over 10 years, about half of all low- and intermediate-risk patients who select surveillance over treatment will eventually must undergo treatment, he said.

But “energetic surveillance allows us to look at these cancers closely, using blood tests, imaging modalities and biopsies to make sure they don’t progress,” Al Hussein Al Awamlh added.

The major goal: to “avoid subjecting patients to the unintended effects of upfront radiation or surgery that affect urinary and sexual function,” he explained.

And that’s not a minor concern, said Dr. Yaw Nyame, an assistant professor within the department of urology on the University of Washington School of Medicine, in Seattle.

Nyame, who was not involved within the investigation, said he “all the time likes to remind folks that each one of our treatments which are confined to the prostate have the potential to affect a patient’s quality of life, by impacting urinary function, bowel function and sexual function.”

And a few of those unintended effects may be “life-altering,” he noted, provided that prostate surgery entails a 15% risk for incontinence and a 50% risk for erectile dysfunction within the five years post-treatment.

Radiation also entails an identical sexual function risk, Nyame added, alongside a “pretty high rate” for so-called urination frequency, diarrhea and bowel disturbances over the six to 12 months following treatment.

“So, for me, the danger of dying from prostate cancer must be large enough without treatment that it makes all of those treatment unintended effects worthwhile,” Nyame said.

That’s where energetic surveillances is available in, said Al Hussein Al Awamlh. By definition, when a cancer is deemed to be low-risk it signifies that the possibilities that the cancer will ultimately spread stays low. And “we consider we will catch these cancers before they progress,” he said.

So how do doctors know when a patient has low- or intermediate-risk prostate cancer, versus aggressive late-stage cases requiring immediate intervention?

Al Hussein Al Awamlh said a determination is made on the premise of things equivalent to tumor size; biopsy results; blood tests designed to measure levels of prostate-specific antigen (PSA); and whether or not the cancer in query “has broken through the skin layer of the prostate.”

Nyame said, for the reason that early 2000s, several studies have shown that for those diagnosed with low- or medium-risk disease, “the energetic surveillance strategy is protected.” Amongst those that select surveillance, only about 3% find yourself with advanced stage 4 cancer over 10 years, he noted, and lower than 1% die from their illness.

For that reason, each Al Hussein Al Awamlh and Nyame identified that public health guidelines — like those outlined by the National Comprehensive Cancer Network — strongly advise doctors to advocate for energetic surveillance over immediate treatment when appropriate.

The present study suggests the message has been catching on.

The investigators analyzed information from a U.S. database including men over 40 who had been diagnosed with low or “favorable” intermediate-risk prostate cancer between 2010 and 2018. During that point, energetic surveillance numbers jumped to 60% and 22%, respectively, in keeping with the report.

The excellent news got here with some caveats, nonetheless. The study authors noted that American patients are still much less prone to select surveillance than their European peers.

As well as, energetic surveillance was less often presented as an option and/or chosen by Hispanic men, rural residents and men of lower means, the study revealed. That, said Nyame, suggests “we’re not equitable in how we approach this.”

The findings were published online April 3 in JAMA Internal Medicine.

More information

There’s more on energetic surveillance of prostate cancer on the American Cancer Society.

SOURCES: Bashir Al Hussein Al Awamlh, MD, urologic oncology fellow, department of urology, Vanderbilt University Medical Center, Nashville, Tenn.; Yaw A. Nyame, MD, MS, MBA, assistant professor, University of Washington School of Medicine, Seattle, and physician, Fred Hutch Cancer Center; JAMA Internal Medicine, April 3, 2023, online


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