Home Men Health Long-Term Study Supports ‘Watch and Wait’ for Most Prostate Cancers

Long-Term Study Supports ‘Watch and Wait’ for Most Prostate Cancers

Long-Term Study Supports ‘Watch and Wait’ for Most Prostate Cancers

MONDAY, March 13, 2023 (HealthDay News) — A person with prostate cancer who takes the “watch-and-wait” approach has the identical long-term survival odds as those that undergo radiation therapy or surgery, in keeping with a brand new large-scale study.

Patients had the identical 97% survival rate after a decade and a half whether doctors treated their tumor or just put it under remark, British researchers found.

“Survival from prostate cancer was high after 15 years of follow-up, whether patients received radiotherapy, prostatectomy [prostate removal] or lively monitoring,” said study co-author Jenny Donovan, a professor of social medicine with the University of Bristol. “Only 3% of patients within the study died from prostate cancer.”

Researchers presented the findings last weekend on the European Association of Urology’s annual meeting, in Milan, and the outcomes were published concurrently within the Latest England Journal of Medicine.

For the study, researchers evaluated nearly 82,500 men in the UK who underwent a prostate-specific antigen (PSA) test between 1999 and 2009.

The study recruited just over 1,600 men diagnosed with localized prostate cancer in consequence of their screening and randomly assigned them to one among three groups — an lively monitoring group, a gaggle that underwent surgery to remove their prostate, and a gaggle that received radiation therapy for his or her cancer.

After 15 years, only 45 had died — 17 within the lively monitoring group, 12 within the surgery group and 16 within the radiation therapy group.

Men on lively monitoring were more more likely to see their cancer progress or spread, but this didn’t reduce their possibilities of long-term survival.

Because of this, the researchers concluded that men diagnosed with low- or moderate-risk prostate cancer don’t have to panic and rush their treatment decisions.

“Many patients with prostate cancer contained to the prostate could delay or forgo radical treatment without compromising quality of life or longevity,” Donovan said. “All men with low-risk and plenty of with moderate-risk prostate cancer could safely select surveillance over surgery or radiation.”

The brand new study adds more fuel to the continued controversy over the advantages and risks of prostate cancer screening.

Prostate cancer rates in the US rose by 3% a yr between 2014 and 2019 after 20 years of decline, and advanced prostate cancers increased by about 5% a yr, the newest American Cancer Society statistics show.

Because of this, some experts are rethinking guidelines that currently leave prostate cancer screening a private alternative between a person and his doctor.

The American Cancer Society (ACS) is reevaluating its own guidelines, which recommend that doctors discuss screening at age 40 for men with an in depth relative who’s had prostate cancer, at 45 for men at high risk of prostate cancer, and at 50 for nearly all other men, ACS Chief Scientific Officer Dr. William Dahut said.

“I actually think having the PSA value does make it much easier to have shared decision-making,” Dahut said. “If the PSA value could be very high, that puts you forward to perhaps consider an MRI after which a biopsy. If it’s very low, don’t do anything about it. If it’s in the center, then we watch it for some time. But not having that number, I do think it makes it far more difficult to essentially give good advice.”

Nonetheless, Donovan said these latest results seem to point that more prostate cancer screening will only result in unnecessary medical procedures.

“Men should rigorously consider all of the potential consequences of getting a PSA test before deciding to have one,” Donovan said. “A PSA test could be followed by a snowball of further testing, including biopsies of the prostate, and, if there may be a cancer, the chances are it could be of localized and low-risk. Then there will probably be difficult decisions to make about treatment, and a ‘healthy’ man can turn out to be a ‘cancer patient’ unnecessarily.”

Dahut did note that just about twice as many men assigned to lively monitoring had their prostate cancer spread into other parts of the body in the course of the 15-year follow up — 51 men (9.4%) within the active-surveillance group, compared with 26 (4.7%) within the surgery group and 27 (5%) within the radiation group.

“The proven fact that individuals who could have had treatment and will have potentially never had their cancer come back as a substitute waited until the cancer was metastatic. For me, that’s really quite concerning,” Dahut said.

Other experts take a unique view, arguing that the study shows even men with metastases don’t necessarily die from their prostate cancer.

“The proven fact that the greater progression of disease seen under lively monitoring didn’t translate into higher mortality will probably be each surprising and inspiring to urologists and patients,” Dr. Peter Albers, a urologist at Dusseldorf University and chair of the European Association of Urology’s Scientific Congress, said in a gathering news release.

“Energetic monitoring and biopsy protocols today are far more advanced than on the time this trial was conducted, so it’s possible we could improve on these outcomes still further. It’s a crucial message for patients that delaying treatment is protected, especially as which means delaying unintended effects as well,” said Albers, who was not involved within the study.

Patients from all three groups reported an identical overall quality of life, however the negative effects of treatment on urinary, bowel and sexual function continued for much longer than previously thought.

Men who underwent surgery or radiation therapy suffered from incontinence, impotence and other unintended effects for as much as 12 years, researchers said.

“Surgery can result in reduction in sexual function in addition to urine leakage, which can require 1 in 5 men to wear pads for cover,” Donovan said. “Radiotherapy results in a decline in sexual function, and in addition some fecal leakage can occur.”

The clinical trial also highlighted flaws within the screening methods used to predict which prostate cancers are more likely to grow quickly and spread.

Initially, about 3 out of 4 (77%) of the participants were deemed to have low-risk cancer, but a reassessment using more modern methods showed that a far greater number would now be considered to have intermediate-risk cancer.

In actual fact, in about 30% of the lads their cancer had already spread beyond the prostate.

Dahut noted that monitoring of diagnosed prostate cancers has vastly improved since this trial began, and is far more sophisticated lately.

“We’ve evolved a bit bit from the term ‘watchful waiting’ to the term ‘lively surveillance,’” Dahut said. “It’s a really lively process now where you’re monitoring the cancer and if there are changes of concern, you then reassess whether intervention is required. Today, we might monitor them more intensively, oftentimes using MRI.”

More information

The American Cancer Society has more on prostate cancer screening.

SOURCES: Jenny Donovan, PhD, professor, social medicine, University of Bristol; William Dahut, MD, chief scientific officer, American Cancer Society; Latest England Journal of Medicine, March 11, 2023; European Association of Urology, news release, March 11, 2023


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