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 About one half of one percent of the men died of their cancer during
up to 18 years of follow-up.
Some prostate cancers do need to be treated on diagnosis, but older
men with small, slow-growing cancers may die of other causes – often
heart disease – before their prostate cancer shortens their
lifespan, the authors note August 31 in the Journal of Clinical
Oncology.
“Our goal was to make absolutely sure we identified the people that
we thought would be the absolute safest,” said senior author Dr. H.
Ballentine Carter of Johns Hopkins Hospital in Baltimore.
In the U.S., about 30 to 40% of men who would qualify for active
surveillance for prostate cancer take that option. That proportion
that has slowly increased over time but still lags behind other
countries, Carter told Reuters Health.
The researchers followed 1,268 men, mostly in their 60s, diagnosed
with low-risk or very low-risk prostate cancer in the 2000s.
As part of active surveillance, the men had twice-yearly rectal
exams and blood tests for prostate specific antigen (PSA) and annual
prostate biopsies.
Of the whole group, 650 were followed for at least five years and
184 were followed for at least 10 years.
Over the study period, 49 of the 1,268 men died, 47 of them from
causes other than prostate cancer, and two due to prostate cancer.
Of the two men who died of prostate cancer, both were originally
diagnosed with very low-risk cancer and one of them died within 15
months of diagnosis. The other died 16 years after diagnosis, with a
prostate tumor that was distinct from the one originally diagnosed.
At the 10-year point, 26% of the men had the grade of their cancer
reclassified based on biopsies or other tests. After 15 years, 31%
had been reclassified.
“It’s extremely unlikely someone (meeting low-risk) criteria is
going to be diagnosed with a cancer that is ultimately going to kill
them,” Carter said. For men with very low-risk cancers, “the first
thing you should be asking is not which treatment, but do I need
treatment at all,” he said.
“This is another piece suggesting that, not only does (active
surveillance) appear to be safe, based on this it is incredibly safe
for certain groups of individuals,” Carter said.
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Now that considerable evidence supports active surveillance for many
men, a focus of research should be refining doctors’ ability to
identify which ones are less likely to be safe, writes Dr. Anthony
D. D’Amico of Brigham and Women’s Hospital and Dana Farber Cancer
Institute in Boston in a commentary accompanying the new study.
Race and ethnicity, family history and having other health
conditions all factor into the likelihood of prostate cancer
progression, he notes. As time goes on, it will be easier to fully
personalize prostate cancer treatment or surveillance to each
individual, based on factors like age, ethnicity and genetic
profile.
“In this particular paper, while the data that has been provided is
supportive of surveillance for many men with low-risk prostate
cancer it does not answer the question for all men with prostate
cancer,” D’Amico told Reuters Health.
Few of the men in this sample were African American, and other
studies suggest their risk profiles may differ from those of
Caucasian men, he said.
The results also may not be applicable to older men, in their 70s or
80s, who are otherwise healthy, with no risk for heart disease or
other causes of death, he said.
SOURCE: http://bit.ly/1hylZuI and http://bit.ly/1JBu5MG
J Clin Oncol 2015.
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