The ProtecT trial, led by researchers at the Universities of Oxford and Bristol in nine United Kingdom centres, is the first trial to evaluate the effectiveness, cost-effectiveness and acceptability of three major treatment options: active monitoring, surgery (radical prostatectomy) and radiotherapy for men with localised prostate cancer. The result is a debate – a very heated one – over the best way to screen for prostate cancer, and once it’s found, whether to treat it aggressively with surgery or radiation, or leave it alone.
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According to Dr. Patrick Fowler, MD, at Dignity Health, “Early detection remains the cornerstone of the successful treatment of prostate cancer”.
– 1 in 10 men will develop prostate cancer in their lifetime.
September is Prostate Cancer Awareness month, and there are some worrisome changes occurring with prostate cancer. “If the cancer spreads or progresses, we just pull the trigger” and begin treating it, said oncologist Dr. Marc Garnick of Beth Israel Deaconess Medical Center in Boston, who specializes in prostate cancer and was not involved in the study.
Because prostate cancer is often slow growing, instead of starting treatment with its side-effects, some men and their doctors decide on close surveillance of their cancer, called active monitoring or active surveillance. Most men who have prostate cancer do not die from it, according to the American Cancer Society.
For men with truly low-risk disease, “monitoring at 10 years is not going to increase your risk of death from prostate cancer”.
Prostate cancer has always been an exception in the cancer field.
Between 1999 and 2009, 1,643 men between the ages of 50 and 69 agreed to be monitored while they underwent either active monitoring, radical prostatectomy or radical radiotherapy.
More than half of men with prostate cancer do not need immediate treatment, a study has concluded.
“Patients diagnosed at a later stage of disease, or with a more aggressive cancer, have lower rates of survival, making it vital that we quickly identify those who are at the highest risk”, said Dr. Claus Roehrborn, Chair and Professor of Urology, who holds the E. E. Fogelson and Greer Garson Fogelson Distinguished Chair in Urology and the S.T. Harris Family Chair in Medical Science, in Honor of John D. McConnell, M.D.
Screening refers to finding cancer before someone has symptoms, in the earliest of stages, which improves treatment options and outcomes. Radiotherapy caused more bowel problems than surgery or active monitoring. “There has been a near doubling of metastatic prostate cancers among 55-64-year-olds from 2004 to 2013.This was abstracted in the July 20, 2016 CoC ‘The Brief”.
But here’s the wrinkle: many men can have elevated PSA levels without the disease. While is it not accurate or even prudent to pronounce a patient “cured” or “cancer free” after treatment, follow up exams will show if there is no evidence of disease.
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Urologists and prostate cancer advocacy groups have loudly criticized those recommendations since they were published. “We need to continue to study these men to find out whether prevention of cancer progression by surgery or radiotherapy leads to better cancer control and survival in the longer term”. PSA is a substance made by the prostate and higher levels of PSA in the blood may indicate prostate cancer or other conditions that affect the prostate. Those who underwent surgery or radiation cut in half the risk that their disease would spread to bones and lymph nodes, compared with those who were simply monitored. We also learn that despite this, there were “no significant differences in the death rates between the three groups”.
