Two different views on a study showing that immediate treatment improves survival in PCa patients.
For some men with localized prostate cancer, active surveillance has emerged in recent years as a viable management option. Defined as rigorous monitoring with the option of initiating potentially curative therapy should disease progress, this approach generally has been considered for patients with early, indolent disease (T1c or T2a tumors, a Gleason score of no more than 6, and a PSA level not greater than 10 ng/mL).
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For patients older than 70 years, these criteria have sometimes been more relaxed. Clinicians often have told men under surveillance that their risk of death is virtually the same as it would be if they were treated immediately with surgery or radiation, with its potential complications, such as erectile dysfunction and urinary incontinence.
Then, in late 2006, researchers at the Fox Chase Cancer Center and the University of Pennsylvania, both in Philadelphia, published the results of a large observational study showing that men aged 65-80 who received prompt radical prostatectomy or radiation for localized prostate cancer had a 31% lower risk of dying than did surveillance patients during 12 years of follow-up. The findings were published in the Journal of the American Medical Association (2006;296:2683-2693).
In an interview with Renal & Urology News, Yu-Ning Wong, MD, lead author of the study and a medical oncologist at Fox Chase, pointed out that these results do not mean that surveillance is always a bad idea. “Many men with comorbidities such as significant lung, cardiovascular or kidney disease should undergo active surveillance,” she said, “as should some men who are concerned, justifiably, about the side effects of active treatment.”
Dr. Wong said her study does suggest that prostate cancer management should be decided on a case-by-case basis, and that factors such as advancing age should not be used to rule out aggressive treatment. “It’s a complicated decision, and until recently there was an absence of data showing that active treatment helps these patients,” she explained. “But patients are living longer and healthier these days, which enhances the potential benefit of active treatment.”
Other research, including a study at New York-Presbyterian/Weill Cornell Medical Center, has added fuel to the treatment-is-better fire. Published in the March 2007 Journal of Urology, this study found that patients with aggressive, non-metastatic prostate cancer (Gleason score 8-10) who received prostatectomy or radiation could expect to live twice as long—14 vs. 7 years—as patients under surveillance.
