More men with low-risk prostate cancer are choosing active surveillance

Traditionally, men with low-risk prostate cancer had undergone radical prostatectomy or radiation, but many are now opting for a more conservative active surveillance approach, according to a Feb. 11 analysis published in JAMA.

How many more men are taking the conservative road? Researchers at Dana-Farber Cancer Institute in Boston analyzed more than 164,000 men diagnosed with localized prostate cancer between 2010 and 2015. They found the number of men who chose active surveillance increased to 42.1 percent from 14.5 percent over the five-year period.

During the same time period the percentage of men undergoing invasive radical prostatectomy fell to 31.3 percent from 47.4 percent. Radiotherapy’s use for low-risk patients also declined from 38 percent to 26.6 percent.

“This encouraging finding suggests that clinicians are better adhering to current recommendations and guidelines for men with low-risk prostate cancer, as the use of active surveillance in appropriately selected men will reduce rates of overtreatment,” said Howard Soule, PhD, executive vice president and chief science officer of the Prostate Cancer Foundation, in a news release.

Those national recommendations were established in 2010, suggesting men with low-risk prostate cancer undergo conservative management techniques, such as active surveillance, rather than immediate definite treatment with surgery or radiotherapy. Low-risk tumors are considered to be confined to the prostate gland and receive a grade 6 on the Gleason scale.

Patients who opt for conservative active surveillance are told to report symptoms such as changes in urinary habits, pain, irritation or bone pain. The approach includes follow-up tests measuring PSA levels, repeat biopsies and exams every six months.

One surprising find from their research was the increase of radical prostatectomy in high-risk patients from 2010 to 2015. The team found the surgical procedure’s use jumped from 38 percent to 42.8 percent, while radiotherapy decreased from 60.1 percent to 55 percent. The shift away from radiation therapy toward prostatectomy isn’t supported by any high-level studies, suggested Brandon Mahal, MD, with the department of radiation oncology at Dana-Farber, who also led the study.

Overall, Mahal stressed that doctors should discuss conservative treatment with their low-risk patients.

“What we know from high level evidence is that conservative management of low-risk prostate cancer is associated with a very favorable prognosis,” Mahal said, in the same release. “Many men with low-risk disease are able to be spared the toxicity of treatment so it’s an important discussion to have between clinicians and patients.”