Prostate Cancer TX
Panel Endorses Active Monitoring and Delay of Treatment for Low-Risk Prostate Cancer
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An independent panel convened by the National Institutes of Health (NIH) has concluded that many men with localized, low-risk prostate cancer should be closely monitored, permitting treatment to be delayed until warranted by disease progression. The panel also recommended standardizing definitions and conducting additional studies to clarify which monitoring strategies are most likely to optimize patient outcomes.
Prostate cancer is the most common non-skin cancer in men in the United States and affects 30% to 40% of men older than age 50 years. In 2011, approximately 240,000 U.S. men will receive a new diagnosis of prostate cancer; more than half of these cancers are localized, not aggressive at diagnosis, and unlikely to become life-threatening. However, approximately 90% of patients receive immediate treatment, such as surgery or radiation therapy. For many of these patients, treatment has substantial short- and long-term side effects, such as diminished sexual function and loss of urinary control, without clear benefits, such as improved survival. Identifying appropriate management strategies for different subgroups of patients is critical to improving survival and reducing the burden of adverse effects.
Currently, clinicians often describe two alternatives to immediate treatment of low-risk prostate cancer: observation with the intent to cure (active surveillance) and without the intent to cure (watchful waiting). Watchful waiting is a passive approach, with treatment provided to alleviate symptoms if they develop. Active surveillance involves proactive patient follow-up in which blood samples, digital rectal exams, and repeat prostate biopsies are conducted on a regular schedule, and curative treatment is initiated if the cancer progresses.
The panel identified emerging consensus on a definition for low-risk prostate cancer: a prostate-specific antigen (PSA) level less than 10 ng/mL and a Gleason grade of 6 or less. Using this definition, the panel estimated that more than 100,000 men diagnosed with prostate cancer each year would be candidates for active monitoring rather than immediate treatment.
The panel further recommended that because of the very favorable prognosis of PSA-detected, low-risk prostate cancer, that strong consideration be given to removing the anxiety-provoking term “cancer” for this condition.
The panel also found that how you frame your patient’s disease management options is an important factor in his decision-making. While research continues to fill knowledge gaps and develop consensus, the decisions faced by men and their providers following a diagnosis of localized, low-risk prostate cancer should be highly individualized, and include the consideration of biological, psychological, social, and cultural factors.
Jill Shuman, MS, ELS
Published December 13, 2011
Source: Role of Active Surveillance in the Management of Men with Localized Prostate Cancer. Presented at: NIH State-of-the-Science Conference; December 5-7,2011; Bethesda, MD. http://consensus.nih.gov/2011/docs/prostate/ASPC_Program_and_Abstract_Book.pdf. Accessed December 10, 2011.
If the cancer is in its early states, treatment may not be required. The doctor will advice you to wait and watch for the symptoms. If the cancer is still progressing, then you may consider either surgery or radiation treatment. Initially radiation therapy is recommended, if there is not any improvement in your conditions, surgery can be considered as a last option.