According to a decades-long study, many men with prostate cancer can delay or skip harsh treatments, such as surgery or radiation, without compromising their chances of survival.
Instead, their cancer may be “actively monitored” after diagnosis, rather than having their prostate removed or exposed to high-energy radiation. Such treatments can cause lasting side effects, such as urinary leakage, erectile dysfunction and other problems with urinary, bowel and sexual function.
“The good news is that if you are diagnosed with prostate cancer, don’t panic and take your time to make a decision” on how to proceed, lead study author Dr. Freddie Hamdy (opens in a new tab)professor of surgery and urology at the University of Oxford, said CNN (opens in a new tab). Basically, this advice only applies to people with low- or intermediate-risk prostate cancer — those with high-risk cancer still need prompt and aggressive treatment, he said. he declares.
The new study, published on Saturday March 11 in the New England Journal of Medicine (opens in a new tab), included more than 1,600 men in the UK who had been diagnosed with prostate cancer and were aged between 50 and 69 at the start of the trial. These patients were randomly assigned to three groups that received different cancer treatments: one-third had their prostates removed, one-third received radiotherapy in combination with short-term hormone-blocking therapy, and one-third underwent monitoring. active, now commonly referred to as “active standby.”
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During the study, which began in 1999, active monitoring involved regularly measuring the levels of a specific protein in the patients’ blood. Levels of this protein, called prostate-specific antigen (PSA), tend to increase as prostate cancer progresses. Today, active surveillance may involve additional tests, such as magnetic resonance imaging (MRI) of the prostate and genetic testing, Dr. Olivier Sartor (opens in a new tab)medical director of the Tulane Cancer Center, wrote in a comment (opens in a new tab) of research.
The researchers followed each participant for 11 to 21 years after diagnosis and found that all patients had a similar risk of death, regardless of the treatment they received. Overall, 45 participants, or 2.7%, died of prostate cancer. This included 12 people (2.2%) in the surgery group; 16 people (2.9%) in the radiological group; and 17 people (3.1%) in the active surveillance group; these small differences are not considered statistically significant.
Over the approximately 15-year follow-up period, approximately 330 men in the surveillance group, or 60%, eventually underwent surgery or radiation therapy. But waiting for treatment does not seem to have an impact on their risk of death. In addition, 133 people in the monitoring group never had surgery, radiation therapy or hormone blocking therapy and still survived.
At 15 years after diagnosis, the cancer had metastasized or spread in 9.4% of the active surveillance group, 4.7% of the surgery group and 5% of the radiation therapy group. However, the surveillance group might have fared better if the study had been conducted with today’s surveillance methods, Dr Stacy Loeb (opens in a new tab)a prostate cancer specialist at NYU Langone Health who was not involved in the research, said The Associated Press (opens in a new tab). “We now have more ways to help detect that the disease is progressing before it spreads,” Loeb said.
Crucially, “the vast majority of patients in the trial were at favorable low or intermediate risk and would today be considered suitable candidates for active surveillance”, and only a small fraction of participants in the study would be considered high risk and needy. immediate treatment, writes Sartor in his commentary.
In general, high-risk prostate cancer diagnoses make up only 15% of cases — so most of the time, prostate cancer is low-to-intermediate risk, CNN reported. For low-risk patients, the potential risks and benefits of surgery and radiation therapy should be carefully weighed, because “more aggressive therapy may cause more harm than good,” the study authors concluded.