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Active Monitoring for Prostate Cancer Okay, Study Confirms

Our primary care doctors in Delray Beach have some good news for those with prostate cancer: A new study reassures those men that the common practice of “active monitoring” rather than aggressive treatment is the right approach in most cases.

According to a study released last month in the New England Journal of Medicine, active monitoring has the same high survival rates after 15 years as more aggressive medical treatment.

Prostate cancer is the second-most common cancer diagnosed in men the in U.S., after non-melanoma skin cancers, according to the National Cancer Institute (NCI). About 11 percent of Americans will be diagnosed with prostate cancer in their lifetime, and of those, about 2.5 percent will die from it.

The Study

As part of the ProtecT trial in Britain, researchers recruited 1,641 men diagnosed with localized prostate cancer to participate in their clinical trial. They were divided into three groups: a third received a prostatectomy (surgical removal of the prostate), a third received radiation therapy and three to six months of androgen deprivation therapy, and a third actively monitored over time. Because prostate cancer takes so long to progress, it took many years to evaluate the various approaches.

After 15 years, patients in the study had the same 97 percent survival rate, regardless of treatment or surveillance. Twenty-two percent of the participants had died from all causes, and 2.7 percent had died of prostate cancer.

In the active monitoring group, 3.1 percent died of prostate cancer, as opposed to 2.9 percent in the radiation group, and 2.2 percent in the surgery group. These differences are not considered statistically significant, according to the researchers.

Around a quarter of those in the active monitoring group still hadn’t received more aggressive treatment after 15 years. Men in the active monitoring group were more likely to see their cancer spread, but this didn’t reduce their chances of long-term survival.

“This is very good news,” lead study author Freddie Hamdy, a professor of surgery and urology at the University of Oxford, said in a statement.

“Most men with localized prostate cancer are likely to live for a long time, whether or not they receive invasive treatment and whether or not their disease has spread, so a quick decision for treatment is not necessary and could cause harm,” he added.

“It’s also now clear that a small group of men with the aggressive disease are unable to benefit from any of the current treatments, however early these are given,” Hamdy said.

Updated Approach

Over the last few years, many doctors have been moving away from regular prostate-specific antigen (PSA) screening; in 2018, however, the U.S. Preventive Services Task Force (USPTF) still recommended PSA screening for men ages 55 to 69.

But CNN reports that over the years, studies and modeling have shown that regular screening for an elevated PSA may do more harm than good because an elevated PSA can not only result from cancer but also from infections as well as from such benign activities as sexual relations and even riding a bicycle.

This can lead to follow-up tests such as imaging and biopsies, along with the accompanying stress, for little real return.

In a separate paper published along with the main study, the researchers wrote that many men who experience more aggressive treatments come to regret it for as long as 12 years afterward. That’s because the side effects can include urinary and fecal leakage and erectile dysfunction, along with anxiety and depression.

This new research can reassure men who are hesitant to undergo aggressive treatment that they may fare just as well with active monitoring.

“Now, men diagnosed with localized prostate cancer can use their own values and priorities when making the difficult decisions about which treatment to choose,” Jenny Donovan, a professor of social medicine at the University of Bristol and a co-author of the study, said in a news release.

The Exceptions

“It is generally thought that only about 30 percent of the individuals with an elevated PSA will actually have cancer, and of those that do have cancer, the majority don’t need to be treated,” Dr. Oliver Sartor, medical director of the Tulane Cancer Center, said in an editorial accompanying the study. Sartor was not involved in the research.

But this study—and the active surveillance approach—doesn’t apply to everyone.

CNN emphasizes that the findings do not apply to men whose cancers found during testing are high-risk and high-grade. These aggressive cancers, which account for about 15 percent of all prostate cancer diagnoses, still need prompt treatment, according to study author Hamdy.

He stressed that the results apply only to those with low or medium risk of their cancer progressing.

“High-risk patients need quick and aggressive treatments,” he said in a statement.

But it’s still good news for the majority of men diagnosed with prostate cancer.

“When men are carefully evaluated and their risk assessed, you can delay or avoid treatment without missing the chance to cure a large fraction of patients,” Bruce Trock, a professor of urology, epidemiology, and oncology at Johns Hopkins University, who was not involved in the study, told CNN.

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