Researchers have found long-term evidence that actively monitoring localized prostate cancer is a safe alternative to immediate surgery or radiation.
Prostate cancer specialist Dr. Stacey Loeb of NYU Langone Health said the results released Saturday are encouraging for men who want to avoid treatment-related sexual and incontinence problems.
The study directly compared three approaches – surgery to remove the tumour, radiation treatment and surveillance. Most prostate cancer grows slowly, so it takes years to see the consequences of the disease.
“There was no difference in prostate cancer mortality at 15 years between the groups,” Loeb said. And prostate cancer survival was high for all three groups — 97% regardless of treatment approach. “That’s also great news.”
The results were published Saturday in the New England Journal of Medicine and presented at the European Association of Urology conference in Milan, Italy. Britain’s National Institute for Health and Care Research paid for the research.
Lead author Dr Freddy Hamdy, from the University of Oxford, said men with localized prostate cancer should not panic or rush into treatment decisions. Instead, they should “carefully consider the potential benefits and harms of treatment options.”
He added that a small number of men who are at high risk or with more advanced disease require immediate treatment.
Researchers followed more than 1,600 UK men who agreed to be randomly assigned to receive surgery, radiation or active surveillance. The patients’ cancer was confined to the prostate, a walnut-sized gland that is part of the reproductive system. The men in the observation group had regular blood tests and some had surgery or radiation.
Death from prostate cancer occurred in 3.1% of the active-surveillance group, 2.2% in the surgery group, and 2.9% in the radiation group, a difference considered statistically insignificant.
At 15 years, cancer had spread in 9.4% of the active-surveillance group, 4.7% of the surgery group, and 5% of the radiation group. The study was started in 1999, and experts say monitoring practices are better today, with MRI imaging and gene testing guiding decisions.
“We have more ways to help catch this disease before it starts spreading,” Loeb said. In the US, about 60% of low-risk patients choose surveillance, now called active surveillance.
Hamdy said the researchers had seen a difference in cancer spread at 10 years and expected a difference in survival at 15 years, “but it didn’t.” He added that prostate cancer death cannot be predicted by spread alone.
“This is a new and interesting finding, which is useful for men when they are making decisions about treatment,” he said.
