Men with low-risk prostate cancer opt for conservative approaches instead of aggressive treatments

More men with low-risk prostate cancer are opting for conservative management of the disease instead of immediate surgery or radiation, according to a recent JAMA study

“Utilization of conservative management has increased significantly among US veterans with low-risk prostate cancer, suggesting a substantial reduction in overtreatment during the past decade,” wrote first author Stacey Loeb, MD, with Manhattan Veterans Affairs (VA) Medical Center in New York, and colleagues.

Through the VA’s Central Data Warehouse, Loeb and colleagues from New York University examined treatment patterns of 125,083 veterans diagnosed with low-risk prostate cancer from January 2005 through November 2015.

The group found that only 27 percent of men under 65 passed on immediate therapy in 2005, instead opting for “watchful waiting” or “active surveillance.” A decade later, in 2015, 72 percent of men decided a more conservative approach was more beneficial. The trend for men over 65 was similar.

Authors noted these results are higher than previous studies. This included a prior 2010 to 2011 U.S. study analyzing an active management strategy—the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database analysis—found 32 percent of suitable patients chose conservative management.

“Despite some regional variation suggesting additional room for improvement in the VA, these data suggest that an integrated health care system with equitable access for patients and without volume-based incentives for physicians may overcome many barriers to guideline-recommended conservative management,” authors wrote.