Men with early-stage prostate cancer are increasingly opting for regular monitoring and holding off on treatment unless the disease progresses. New study shows the use of so-called active surveillance or watchful waiting among men with localized PC was low from 1990-2009. But treatment option increased between 2010-2013.
Many men whose tumors are confined to the prostate do not die of the cancer, according to the U.S. Centers for Disease Control and Prevention. Men using active surveillance may undergo tests or biopsies to make sure the cancer isn't growing, the ACS says. The approach helps avoid more aggressive treatments, which can carry the risk for complications such as incontinence and impotence.
- Data analyzed 10,472 men with localized prostate cancer treated at 45 U.S. urology practices between 1990-2013
- Use of active surveillance among men with low-risk cancer ranged from 7-14% from 1990-2009
- But then increased 40% between 2010 and 2013
Scientists did say the ideal rate of active surveillance for low-grade disease isn’t clear but it’s probably higher than 40%, experts said. Among men age 75 or older, 76 percent opted for surveillance from 2010 through 2013, researchers found. Researchers found that use of a therapy called androgen deprivation for intermediate-high risk cancers decreased by end of the study.
Radiation hasn’t been endorsed as single therapy for localized disease. Researchers hope with men choosing surveillance for prostate cancer, researchers hope it will reopen the discussion on screening and the PSA blood test.
One argument against PSA screening is that men may go on to have aggressive treatment for cancer that might never have caused them problems. The researchers hope the decline in use of aggressive treatments - as inferred from the increase in surveillance - will lead to a re-evaluation of the risks of PSA testing.
"Our hope is that these findings and other papers with similar findings will really start to reopen the question on early detection and screening," Cooperberg said. Currently, the government-backed U.S. Preventive Services Task Force (USPSTF) recommends against screening for PSA levels.
The American Urological Association recommends against PSA screening in men younger than 40. It does not recommend routine screening between ages 40 and 54, or after age 70 for men with less than a 10 to 15 year life expectancy. It recommends that men ages 55 to 69 decide about PSA testing after discussions with their doctors.