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 That result is similar to outcomes in men whose cancers are treated
immediately, the authors write.
Prostate cancer often grows very slowly. In some men, such as the
elderly or those with serious health problems, it may never need to
be treated, says the American Cancer Society.
In the Canadian trial, 993 men with low or intermediate risk cancers
were enrolled in active surveillance between 1995 and 2013. By now,
more than 200 of them have been observed for more than 10 years and
50 for more than 15 years.
“This is the third time we’ve published the key results of our long
term surveillance cohort,” said lead author Dr. Laurence Klotz of
Sunnybrook Health Sciences Center in Toronto.
The men were monitored with regular testing. Treatment was started
if the cancer progressed.
As of now, only 27 percent of the men have been treated for their
cancers with radiation therapy, radical prostatectomy or
androgen-deprivation therapy.
Of the 933 patients, 149 have died, but only 15 died from prostate
cancer, the researchers reported in the Journal of Clinical
Oncology.
All the men who died from the cancer had metastases by the end.
Another 13 patients had metastases but died from causes other than
prostate cancer. In all, less than three percent of the men
developed metastatic cancer.
That’s similar to the rate of metastases in another study of men
with low-risk disease who were treated immediately, according to Dr.
Matthew R. Cooperberg of the University of California, San
Francisco.
“In recent years, active surveillance has evolved from an
experimental protocol to a broadly accepted - in fact, preferred -
management strategy for men diagnosed with low-risk prostate
cancer,” he wrote in an editorial in the journal.
Twenty years ago, treating every prostate cancer patient was the
norm, Klotz told Reuters Health by phone.
“Over the years this has evolved,” he said.
“This whole approach is one of evolution and we can do better with
that one or 1.5 percent,” who end up dying from the disease, Klotz
said.
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In this group of low-risk cancers, about 25 percent turned out to be
“wolves in sheep’s clothing,” he said. Those that metastasized
weren’t low-grade disease that spread, rather they were hidden
higher-grade disease that doctors missed, he said.
But doctors are getting better at identifying those cases. Now,
magnetic resonance imaging can detect many of the more dangerous
cancers that may have missed with a biopsy 20 years ago, Klotz said.
Men in the study who died from prostate cancer succumbed about 15
years after diagnosis, usually in their 80s, he noted.
“It really looks like (active surveillance) is a safe strategy for
the management of probably 40 to 50 percent of newly diagnosed
prostate cancer patients,” he said.
Overtreating prostate cancers that would not ultimately be fatal can
lead to incontinence, erectile dysfunction and other problems, he
said.
“That’s why I think this approach is so important, if you can
significantly reduce overtreatment but you still have the benefit of
screening,” Klotz said.
Active surveillance has been widely embraced in Canada and has been
somewhat slower to catch on in the U.S., but is becoming more
common, he said.
“The bottom line is, it’s catching on and I also think the role of
MRI will provide further reassurance,” for doctors and patients,
Klotz said.
SOURCE: http://bit.ly/1wFImCZ Journal of Clinical Oncology, online
December 15, 2014.
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