According to recent studies, an increasing number of American men with early-stage prostate cancer have postponed surgery and radiation therapy.
Instead of getting appropriate medical help, American men with low or intermediate risk prostate cancer pick “active surveillance,” where the evolution of their condition is closely monitored for any signs that could eventually call for treatment.
In a recent study published in JAMA Internal Medicine, researchers discovered a sharp increase from 16 percent to more than 60 percent since 2010 in the proportion of low risk prostate cancer patients who had chosen active monitoring over rapid treatment.
Surveillance rates have increased among individuals at intermediate risk during the same time period, rising from roughly 8 percent to 22 percent.
The lead author of the research, Dr. Bashir Al Hussein Al Awamlh, mentions that this trend seems to reflect that “professional societies have advocated for active surveillance of low risk cancers for more than a decade now.”
The expert also notes that “The theory behind active surveillance is that some cancer has a low potential to spread outside the prostate and are non-lethal.”
Treatment is not needed in cases like that.
According to the study, during a ten-year period, around half of all low and intermediate risk cancer patients who opt for monitoring over therapy will ultimately still require treatment, he added.
However, as Al Hussein Al Awamlh added, “Active surveillance allows us to watch those cancers closely, using blood tests, imaging modalities and biopsies in order to ensure they don’t progress.”
He also explained that the goal is to “avoid subjecting patients to all the side effects of upfront radiation or surgery affecting urinary and sexual function.”
And that should not be taken lightly, according to Dr. Yaw Nyame, an assistant urology professor at the University of Washington School of Medicine, Seattle.
Dr. Nyame, an expert who was not directly involved in the study, shared that he “always likes to remind people that all our treatments that are confined to the prostate have a potential to impact quality of life, by impacting urinary and bowel function as well as sexual function.”
And considering that prostate surgery carries a 15 percent risk for incontinence and a 50 percent risk for erectile dysfunctions in the 5 years following treatment, some of these side effects can be “life-altering,” the expert stressed.
Along with a “very high rate” of reported urine frequency, diarrhea, and bowel abnormalities in the 6-12 months following treatment, radiation also carries a danger to sexual function, according to Nyame.
Nyame noted that “For me, the risk of dying from prostate cancer needs to be big enough without treatment that it makes all these treatment side effects worthwhile.”
Al Hussein Al Awamlh said that is the kind of situation where active surveillance comes into play. When a cancer diagnosis is considered low-risk, it implies that there is little probability that it may eventually spread. Additionally, he added, “we think we can catch these cancers early.”
How do medical professionals distinguish between aggressive late stage prostate cancer cases requiring prompt treatment and patients with low or intermediate-risk prostate cancer?
Al Hussein Al Awamlh stated that a decision is made based on elements such as tumor size, biopsy findings, prostate specific antigen (PSA) blood results, and whether or not the cancer “has burst through the exterior layer of the prostate.”
According to Nyame, multiple studies conducted since early 2000s have demonstrated that “the active monitoring technique is safe” for patients with low or intermediate risk diseases.
He highlighted that among people who choose monitoring, just approximately 3 percent of them develop severe stage 4 cancer during a 10 year period, and less than 1 percent pass away as a result of their condition.
Both Al Hussein Al Awamlh and Nyame cited this as the reason why public health recommendations, such as those provided by the National Comprehensive Cancer Network, strongly encourage physicians to promote active monitoring over quick treatment when necessary.
And according to the present survey, the message has been getting through to people.
The researchers examined data from a U.S. database that included information on males over the age of 40 who had had a low risk or “favorable” intermediate risk prostate cancer between 2010 and 2018.
The research states that throughout that time, the percentages of active surveillance increased to 60 percent and 22 percent, respectively.
However, there were some limitations. The authors of the study stated that compared to their European counterparts, American patients continue to be far less likely to select monitoring.
The study also found that Hispanic males, men living in rural areas, and men from lower socioeconomic backgrounds were less likely to be given the choice of active surveillance and/or to choose it.