Prostate cancer study shows some men can avoid or delay aggressive treatments


LONDON – More men with prostate cancer could afford to delay their treatment, according to a study spanning decades, suggesting active monitoring by medical professionals is an equally valid – and less severe – option. .

The study, published in the New England Journal of Medicine on Saturday, followed more than 1,600 men newly diagnosed with localized prostate cancer in the UK. Up to 21 years after diagnosis, the study found that patients’ risk of death was low whether they were actively monitored or treated with radiation or surgery.

More aggressive treatment helped slow the progression of the disease, but did not reduce the men’s overall risk of dying from the disease. The authors say this finding suggests that “more aggressive therapy may do more harm than good” – because the side effects of these treatments can be debilitating for patients and may not pay off in the end.

This is “very good news for patients,” said Freddie Hamdy, professor of surgery and urology at the University of Oxford and lead author of the study. This means more men could afford to delay aggressive treatments that could leave them with lasting side effects, as long as they are closely monitored for any changes in their condition.

This kind of monitoring is already being offered to low-risk prostate cancer patients in the UK and US, but this study suggests it ‘can be safely extended to intermediate-risk conditions’ , Hamdy said. This could give some hope to people affected by prostate cancer, which is the fourth most common type of cancer in the world.

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In the study, which was funded by the UK government, more than 80,000 men between the ages of 50 and 69 were screened for prostate cancer between 1999 and 2009. More than 2,600 were diagnosed with the disease and 1,643 were enrolled in the trial.

The men were at low or intermediate risk for their disease, and the authors emphasized that their findings do not apply to high-risk men. “High-risk patients need fast and aggressive treatments,” Hamdy said.

The researchers divided the men in the cohort into three groups who were either followed up over time or treated with radiation therapy or prostatectomy, a surgery to remove all or part of a patient’s prostate. The aim was to measure and compare the effectiveness of each treatment.

At a median of 15 years after diagnosis, the men received follow-up to see how they were doing. Less than 3% had died from prostate cancer and the odds were similar for each treatment group. For example, 3.1% of deaths occurred in men in the active surveillance group, while 2.9% were in men who received radiation therapy.

Without treatment, men in the active surveillance group were almost twice as likely to see their prostate cancer progress and spread – or form what are called metastases – than men in the aggressive treatment groups. But this progression did not lead to a higher probability of death. This surprised the researchers, according to Hamdy, who said it suggests that “if men develop metastases, it doesn’t necessarily mean they will die of prostate cancer” – although they could die from other causes. .

Since prostate cancers generally grow slowly, even if the cancer grows faster under active surveillance, the study results suggest that the long-term deleterious effects of harsh treatment may not be worth it.

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Active surveillance, also known as active surveillance, is already used for many low-risk men. That doesn’t mean “doing nothing,” Hamdy said. Patients under active surveillance are regularly tested by a clinician for “any indication that the disease is progressing”. If the cancer progresses, the patient may need surgery, radiation therapy, or hormone therapy. In the study, most of the men in the active surveillance group eventually received a more aggressive form of treatment.

Jenny Donovan, professor of social medicine at the University of Bristol and co-author of the study, said some men make the decision to undergo aggressive forms of treatment because they don’t fully understand they might delay these treatments without affecting their chances of survival – and some later “regret their decisions”.

In a separate article, also published Saturday in the same medical journal, researchers revealed that many men who undergo aggressive treatments report negative side effects lasting up to 12 years. These side effects include bladder leakage and erectile dysfunction. They “arise fairly soon after treatment, but then last long term,” said Donovan, who argues that it’s important for patients to weigh these effects against the likely benefits of treatments.

“Now, men diagnosed with localized prostate cancer can use their own values ​​and priorities when making difficult decisions about which treatment to choose,” Donovan said in a press release.

Overall, the study shows that patients “shouldn’t panic if they are diagnosed with prostate cancer,” Hamdy said. “But if they are high risk, they really need to seek advice and be treated well.”

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