Study: Active Surveillance OK for Some Men with Prostate Cancer

Article date: December 2, 2010

By Rebecca Snowden

Older men with low-grade prostate cancer who choose to closely monitor their disease rather than actively treat it (an approach known as "active surveillance”) can expect better quality of life compared to men who opted for surgery or radiation, according to an analysis based on available medical evidence on prostate cancer treatment outcomes.

The study, which was published in the Journal of the American Medical Association (JAMA), did not indicate that one prostate cancer treatment option is necessarily better than another, but suggests that men should be made more aware of active surveillance as a viable choice.

“Based on the current medical literature, active surveillance stacks up at least as well if not better than active treatment in terms of quality of life for men age 65 and older with low-risk prostate cancer,” says Durado Brooks, MD, American Cancer Society director of prostate and colorectal cancer. “However, it is important to note that this study did not look at treatment outcomes in younger men or those at high-risk, such as African American men and those with a family history of the disease.”

Many Men Not Choosing Active Surveillance

Active surveillance is often recommended for men with prostate cancers that are small, localized, are causing no symptoms, and are expected to grow very slowly. It involves close monitoring with PSA tests, rectal exams, and serial biopsies. This approach is often recommended for older men, for whom it’s not clear that active treatment would actually help them live longer. It also saves these men from the unpleasant side effects of treatment, such as incontinence and impotence.

“The appeal of active surveillance is both the desire to avoid overtreatment and the concern about how treatment affects quality of life,” write Ian M. Thomson, MD, and Laurence Klotz, MD, in an accompanying JAMA editorial.

However, less than 10% of men choose active surveillance, even if it’s recommended, and instead opt for active treatment despite concerns over side effects.

“For many men it’s unthinkable not to actively treat the cancer once it’s found,” says Brooks. “Or perhaps men aren’t aware that active surveillance is a reasonable choice.”

What This Study Found

In this study, researchers looked at the impact of prostate cancer treatment options using sophisticated computer modeling software. They included a broad range of quality of life indicators associated with prostate cancer treatment, from post-treatment side effects like urinary problems to anxiety associated with active surveillance. (So far there hasn’t been a study comparing prostate cancer treatment options. Studies directly comparing treatment options are difficult to do because patients often have strong feelings about their treatment and refuse to be randomly assigned to a particular group.)

They found that active surveillance was associated with better quality of life than other treatment options, but the researchers note that it all depends on the individual. For example, if the anxiety of not actively treating prostate cancer is so great that it affects a man’s quality of life, active treatment may be preferable.

What matters is that men consider all treatment options that fit their situation, including active surveillance.

Promising Research

“There’s not a lot of good information out there comparing prostate cancer treatment options,” says Brooks. “This study is a step in the right direction.”

Other studies currently underway may help clarify the differences in expected outcomes between treatment options.

A large study sponsored by the National Cancer Institute and the Veterans Affairs Cooperative Studies Program is now looking into how active treatment affects survival and quality of life of prostate cancer patients of different ages. There are also studies underway to determine the best approach for monitoring patients on active surveillance which should shed more light on this issue.

There’s also a need for better markers to help determine which prostate cancers are likely to progress. There has been promising work in this area.

In the meantime, patients should talk to their doctors about the pros and cons of prostate cancer treatment. For more information about prostate cancer treatment, see our Detailed Guide.

Citation: “Active Surveillance Compared With Initial Treatment for Men With Low-Risk Prostate Cancer: A Decision Analysis.” Published in the December 1, 2010 issue of the Journal of the American Medical Association. First author: Julia H. Hayes, MD. Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School.

“Active Surveillance for Prostate Cancer.” Published in the December 1, 2010 issue of the Journal of the American Medical Association. Ian M. Thompson, MD, and Laurence Klotz, MD.