Researchers have found long-term evidence that active surveillance of localized prostate cancer is a safe alternative to immediate surgery or radiation.
The results, released Saturday, are encouraging for men who want to avoid treatment-related sexual and incontinence problems, said Stacy Loeb, M.D., a prostate cancer specialist at NYU Langone Health. The doctor was not involved in this research.
This study directly compared three approaches: surgery to remove the tumor, radiotherapy, and monitoring. Because most prostate cancers grow slowly, it takes years to see the outcome of the disease.
“There was no difference in 15-year-old prostate cancer mortality between groups,” Loeb said. And the survival rate for prostate cancer in all three groups was high, 97%, regardless of treatment approach.
The results were published Saturday in the New England Journal of Medicine and presented at the European Urological Congress in Milan, Italy. The UK National Institute for Health and Medical Research paid for the research.
Men diagnosed with localized prostate cancer should not panic or rush into treatment decisions, said lead author Dr. Freddy Hamdi of the University of Oxford. Careful consideration of the benefits and harms that may be caused must be made.
A small number of men with high-risk or more advanced disease need urgent treatment, he added.
Researchers followed more than 1,600 British men who were randomly assigned and agreed to undergo surgery, radiation, or active monitoring. The patient’s cancer was confined to the prostate, a walnut-sized gland that is part of the reproductive system. Men in the surveillance group underwent regular blood tests, and some underwent surgery and radiation therapy.
Death from prostate cancer occurred in 3.1% in the active monitoring group, 2.2% in the surgery group, and 2.9% in the radiotherapy group, a difference that was considered not statistically significant.
At age 15 years, cancer had spread to 9.4% in the active monitoring group, 4.7% in the surgery group, and 5% in the radiotherapy group. The study began in his 1999, and experts say today’s monitoring methods, in which MRI imaging and genetic testing guide decisions, are superior.
“We now have more ways to help us understand disease progression before it spreads,” says Loeb. In the United States, approximately 60% of low-risk patients opt for monitoring, now called active surveillance.
Hamdy said the researchers had seen a difference in cancer spread at 10 years and expected there would be a difference in survival at 15 years, but “it didn’t.” He said spread alone does not predict death from prostate cancer.
“This is a new and interesting finding that will help men make treatment decisions,” he said.
