Active surveillance is safe for prostate cancer at low risk

Active surveillance is safe for prostate cancer at low risk - Active surveillance is becoming a widely adopted alternative for some men with prostate cancer.  

Instead of immediate treatment, men on active surveillance are monitored with periodic biopsies, physical examination and specific tests for prostate antigen (PSA) prostate. Treatment begins only when the cancer shows signs of progression.

But it is safe to wait until then? A new study adds to the growing evidence that the answer is yes, but only for men whose cancers are divided into favorable risk categories.

The study is based on data collected at Johns Hopkins Hospital in Baltimore, Maryland, the site of an active long-term monitoring program. The authors studied nearly 1,300 men who were enrolled in active surveillance between 1995 and 2014.  

Most of the men had "very low-risk cancer," which means their PSA levels were too high at diagnosis and only small amounts of low-grade cancer was found in a maximum of 2 nuclei in a standard 12-core biopsy. The rest was a category of "low risk", which means that the low-grade cancer was detected in no more than 5 cores.

The men averaged 66 years old at diagnosis. At the time of analysis, 49 men were dead was complete, but only two of them for prostate cancer. The rates of specific cancers in the categories of both low-risk and low-risk combined survival exceeded 99% in both 10 and 15 years of follow up, and the predominant cause of death was by far heart disease.

"These results confirm that men with a favorable risk of cancer should be encouraged to consider active surveillance instead of treatment given the low probability of damage diagnosis," said Dr. Jonathan I. Epstein, professor of pathology, Urology and Oncology, Johns Hopkins Hospital, who led the study.

It is important to note that prostate cancer may worsen active surveillance. During this study, 22% of very low risk men and 31% of low-risk people may need treatment within 15 years. But the processing time began, men were under active surveillance for an average of 8.5 years.

"The very low risk men clearly are the best candidates for active surveillance," said Epstein. "But in the case of cancer, and even low-intermediate risk, health problems and other seniors can increase eligibility."

Epstein added that some men may feel strongly that they do not want to live with cancer, which can lead to opt for active surveillance in favor of treatment. "We try to think of strategies to help these men stay on track," he said.

"The study adds important information about the growing practice of active monitoring of certain populations of men," said Dr. Marc Garnick, Gorman Brothers professor of medicine at Harvard Medical School and Beth Israel Deaconess Medical Center and Editor Chief of the Harvard Knowledge.org prostate. "

But we must also keep in mind that we have no evidence of survival benefit with treatment pro men at risk, or when they are diagnosed or when cancers progress through active surveillance. The benefits of treatment are difficult to not prove the risk of prostate cancer is generally favorable life threatening over the expected life of a man. "
By: Charlie Schmidt