Half of men with low-risk prostate cancer move from surveillance to treatment within a few years
Nearly 50% of men with low-risk prostate cancer initially managed with active surveillance—imaging, biopsies, etc.—transition toward treatment within a few years of their diagnosis.
Canadian researchers analyzed more than 8,500 men with low-grade cancer for their findings, published Aug. 20 in the Journal of Urology.
Use of active surveillance, which typically involves prostate-specific antigen testing, imaging exams and biopsies, jumped from 38% in 2008 to 69% in 2014. A median of four years post-diagnosis, however, 51% of men ditched this approach in favor of surgery, radiation or hormone therapy. Most made the move due to signs of tumor growth.
The findings offer new insights into how long patients can expect to stick with surveillance versus treatment, and what factors into these decisions.
"These population-based data show that while the number of patients initiating active surveillance has significantly increased over time, follow-up shows a relatively high rate of transitioning to other forms of treatment within five years," explained senior author Antonio Finelli, MD, MSc, of the University of Toronto’s Division of Urology.
Results of the observational, population-based study are based on men diagnosed with a Gleason score of 6 or less between January 2008 and December 2014 in Ontario, Canada.
Fifty-one percent of men chose active surveillance as their initial strategy. The proportion of individuals sticking to that approach dropped from 85% at year one to 52% at five years, the authors reported.
Younger men were more likely to embrace definitive treatment, along with those with high-risk features such as elevated PSA levels and a higher number of positive cancer cells following biopsy results. Those treated by urologists, however, were more likely to stick with active surveillance than those under the care of radiation oncologists.
Finelli et al. noted the findings underscore the “dire need” to develop more specific imaging studies and tests to personalize care for those who choose monitoring over immediate treatment.
“Current practice may be improved by the development of quality indicators, targeted continuing education for physicians, and patient education with shared decision making at the onset of active surveillance,” Finelli concluded Friday.
Read the full study here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.