According to D’Amico, “men now who are on surveillance who have had recent hospitalizations for heart attack or stroke should stay on surveillance because the chance of dying of prostate cancer does not increase compared to getting treated” over the time period of the study, he said.
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At issue: What is the best treatment for men diagnosed with prostate cancer that hasn’t spread?
The study involved more than 8,200 men in the United Kingdom between 50 and 69 who were tested for prostate specific antigen.
Anne Mackie, director at Public Health England Screening, said the study provided “key information needed to manage localised prostate cancer”. Researchers followed patients for 10 years and found no difference in death rates between men who were picked at random to have surgery or radiation, or to have “active monitoring” of the cancer, with treatment only if it progressed. This is considerably lower than anticipated when we started the study’.
“The bottom line seems to be that for these men with localised prostate cancer, active monitoring is not significantly more risky and avoids the potential burden of medically induced sexual or bowel impairment”. Even though they were aggressively treated if PSA levels rose abruptly, the men assigned to have their cancer initially monitored were, as a group, more than twice as likely as the others to have it metastacize.
Not surprisingly, this was more common among men who got no treatment but who were watched – 112 of them had their cancer progress, compared to 46 men in each of the other two groups.
The research was published Wednesday by the New England Journal of Medicine. If you do have [radical] treatment, it does improve [the chances the disease will not spread] but you have those side-effects.
“Men with low-risk or intermediate-risk prostate cancer should feel free to select a treatment approach using the data on health-related quality of life and without fear of possibly selecting a less effective cancer therapy”, D’Amico, who was not involved in the research, wrote in a commentary.
“The study shows that there is twice as much metastatic disease in the observed group”, he told NBC News.
But there is now no national screening programme because of issues with the accuracy of PSA tests and their potentially harmful consequences.
Professor David Neal, co-investigator from the Universities of Oxford and Cambridge, said the trial was of “global importance” and had “major implications” for men with PSA-detected localised prostate cancer.
“There’s not a ton of signs or symptoms”, he added, “so really, the only way that we’re gonna know that it’s cooking, until it’s advanced, is if you come in and get screened, we draw some blood, and we do the exams”.
Men are well-known for being reluctant to visit a doctor, whether for an illness or for a routine checkup, but the chance to win a television and meet a NASCAR Hall of Famer drew hundreds of men to a health screening in west Little Rock.
But she added: “The problem with screening at the moment is that the test isn’t very good and we don’t know who to treat”. But co-author Professor Jenny Donovan, of Bristol University, said: ‘If you have cancer which is localised within the prostate, you must not rush into a decision about treatment’.
“There’s been no hard evidence that treating early disease makes a difference”, said Dr. Freddie Hamdy of the University of Oxford, the study’s leader.
Dr Matthew Hobbs, from Prostate Cancer UK, called the discovery over survival rates “hugely positive”.
Because many such men could live decades without becoming seriously ill, physicians are increasingly recommending active surveillance for them, taking action only if their PSA numbers rise markedly in a single year.
Age: The older a man is, the greater his risk for getting prostate cancer.
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The bigger problem is determining at diagnosis which men have potentially lethal disease, Hamdy and Brawley both said – and this study does not answer that question.
