Active Surveillance of Prostate Cancer Increasing in the U.S.

Many men with low-risk disease are being spared prostatectomy, radiation, and androgen deprivation treatment, researchers say.
Many men with low-risk disease are being spared prostatectomy, radiation, and androgen deprivation treatment, researchers say.

(HealthDay News) -- More U.S. physicians are sparing their low-risk prostate cancer patients from prostatectomy, radiation, and androgen deprivation monotherapy in favor of active surveillance/watchful waiting, according to a research letter published in the Journal of the American Medical Association.

The researchers found the use of surveillance for low-risk disease to be 7 to 14% from 1990 through 2009, but increased to 40% in 2010 through 2013. This is "excellent news," study author Matthew Cooperberg, M.D., M.P.H., the Helen Diller Family Chair in Urology at the University of California, San Francisco, told HealthDay. "We expected to see a rise in surveillance rates, but were surprised by the steepness of the trajectory," he said. "This really does represent a paradigm change, and it's faster than the typical pace of medical evolution."

Last week, a study published in JAMA Internal Medicine suggested that the wide majority of men with low-risk prostate cancer between 2010 and 2011 had treatment. But, that study defined low-risk in various ways that included between 11 and 40% of prostate cancer patients. The new study examines the medical records of 10,472 men from 45 urology practices. And, it uses a single definition of low-risk. The current study also looks at information through 2013.

In addition to finding a higher rate of surveillance in all men, the researchers also found that those aged 75 and older were much less likely to get potentially unnecessary treatment. Among low-risk men aged 75 and older, the rate of surveillance rose from 21.9% in 2000-2004 to 76.2% in 2010-2013, the researchers found. As for patients at greater danger, "we're seeing more aggressive management of higher-risk disease with surgery, radiation, or both, which is also a trend toward better management," Cooperberg said.

Source

  1. Matthew R. Cooperberg and Peter R. Carroll. JAMA. 2015;314(1):80-82; doi:10.1001/jama.2015.6036.
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