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 It’s becoming more common for doctors to skip aggressive treatments
like surgery or radiation for men with low-risk prostate tumors in
favor of doing periodic tests to see if tumors grow, a practice
known as active surveillance. But research to date has offered a
mixed verdict on whether this approach is safe for certain men with
a higher risk, including black patients and people with a family
history of prostate tumors.
For the current study, researchers analyzed data from six previously
published studies and found that active surveillance wasn’t linked
with an increased risk of prostate cancer progressing for men with a
family history. One study did, however, find that family history
increased the risk of cancer progression in black men.
“The current findings can help doctors reassure patients that having
a family history of prostate cancer should not automatically exclude
them from being considered for active surveillance, although more
research needs to be done for African American men,” said senior
study author Dr. James Dupree, a urology researcher at the
University of Michigan in Ann Arbor.
Most men with prostate cancer are diagnosed with low-risk tumors
that haven’t spread to other parts of the body. Often, doctors and
patients struggle to choose the best course of action because it's
hard to tell which tumors will grow fast enough to be
life-threatening and which ones might never get big enough to cause
problems.
“Just because a cancer is found, it does not automatically mean it
needs to get treated right away,” Dupree said by email. “In some
cases, cancer should be treated, but in other cases it may not need
immediate treatment and can be managed with active surveillance.”
For example, Dupree and colleagues reviewed one study of 200
patients that didn’t detect a meaningful difference in high-risk
tumors based on whether or not men had a family history. In men who
did have a family history, this study also didn’t find a difference
in risk based on the number of relatives with prostate cancer.
Two other studies in the review looked at biomarkers for prostate
tumors, including results from prostate specific antigen (PSA) tests
that are commonly used to look for these malignancies. Neither study
found family history to be a meaningful predictor of aggressive
prostate cancer.
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In another study, family history wasn’t a good predictor of
aggressive tumors for most men, but it did signal an increased risk
for black men.
One limitation of the research review is that it included only six
studies, the authors note in BJU International.
Still, the findings should reassure men with a family history of
prostate cancer that active surveillance may be a reasonable option
in some cases, said Dr. Behfar Ehdaie, a urologic surgeon at
Memorial Sloan Kettering Cancer Center in New York who wasn’t
involved in the study.
“Screening for prostate cancer saves lives,” Ehdaie said by email.
“However, the decisions after prostate cancer is detected may lead
to overtreatment.”
To strike the right balance, doctors can screen men at a young age
with a PSA blood test to help determine a patient’s future risk,
then recommend an appropriate treatment after a man is diagnosed
with prostate cancer, Ehdaie added.
“Incorporating active surveillance to treat men with low risk
prostate cancer reduces the harms of overtreatment associated with
both surgery and radiation therapy,” Ehdaie said.
SOURCE: http://bit.ly/2pq43YX BJU International, online April 6,
2017.
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