Joe Loree wanted to avoid the aggressive treatment for prostate cancer that he had seen his brother and friend undergo, and opted for a more conservative approach called active surveillance.
It typically means periodic PSA assessments and biopsies, often with MRIs and other tests, to watch for signs that the cancer may be progressing. His hasn’t, so now he can get PSA tests every six months instead of every three. “Definitely progress but it’s still not where we need to be,” said Dr. Matthew Cooperberg, a urologic oncologist at the University of California, San Francisco, and lead author of the study.Changing medical practice often takes a frustratingly long time. In the study, 40% of men with low-risk prostate cancer still had invasive treatment. And approaches vary enormously between urology practices.
Although the cancer in the surveillance group was more likely to metastasize, it didn’t lead to higher mortality. “The benefit of treatment in this population is just not apparent,” said Dr. Oliver Sartor, an oncologist at the Mayo Clinic who specializes in prostate cancer and who wrote an editorial accompanying the study.
But most prostate cancer grows so slowly, if it grows at all, that other illnesses are likely to prove lethal first, especially among older men. During the British study, 1 in 5 men died from other causes, predominantly cardiovascular or respiratory diseases and other cancers. Most of those tumors are deemed “indolent,” meaning that they don’t spread or cause bothersome symptoms.
After six years, 17% of the prostatectomy group still needed pads; among those under active surveillance, it was 8%, and 4% in the radiation group.