Treatment Versus No Treatment of Localized Prostate Cancer Had Similar Results Over 15 Years, 1 Question Raised
Every cancer diagnosis comes with a range of reactions, including the natural inclination to act as quickly as possible to choose and begin treatment.
However, a new study has revealed that, in the case of prostate cancer, over 15 years, outcomes were surprisingly similar for three groups: a prostatectomy group, a radiotherapy group, and a nontreatment group under active monitoring. The study’s authors found that prostate cancer-specific mortality was relatively low regardless of the approach taken.
The Clinical Trial
The new findings are based on 15-year outcomes of the Prostate Testing for Cancer and Treatment (ProtecT) clinical trial sponsored by the University of Oxford. This long-term trial was initiated in 2001 and will continue until 2027.
Here’s a summary of the trial thus far:
- The ProtecT trial included 82,429 men in the United Kingdom between 50 and 69 years of age who received a prostate-specific antigen (PSA) test from 1999 to 2009.
- Localized prostate cancer was diagnosed in 2,664 of the men.
- Researchers followed a subgroup of 1,643 men to assess the efficacy of three approaches: active monitoring, prostatectomy, and radiotherapy.
The three approaches resulted in similar overall survival rates and low rates of disease progression over 15 years.
There are several possible explanations for this finding. The median PSA was relatively low among randomized patients; most of the trial patients were at low risk or favorable intermediate risk and would today be considered appropriate candidates for active surveillance.
Another possibility is that, in most cases, prostate cancer is a slow-growing cancer and may not necessarily lead to death if left untreated for some time.
Notably, patients who received radical prostatectomy or external-beam radiotherapy were more likely to experience adverse effects, such as urinary incontinence and erectile dysfunction, than those on active monitoring.
Based on these findings, the researchers concluded that active monitoring could be appropriate for some men with localized prostate cancer, particularly those with low-risk disease. This approach involves regular monitoring of the cancer with PSA tests and other diagnostic measures, with treatment initiated only if the cancer shows signs of progression.
Overall, the current study findings highlight the importance of balancing the potential benefits and harms of prostate cancer treatments.
The authors published an additional paper on their long-term investigation. In the paper, they explain that effects on sexual, urinary, and bowel function can continue over time for some patients, which is an essential factor for therapy decision-making.
Prostate Cancer Survival Rate Is High, But so Is the Number of Cases
In the United States, 1 in 8 men will be diagnosed with prostate cancer during their lifetimes. Older males and non-Hispanic black men have the highest risk of developing prostate cancer.
Prostate cancer is not usually fatal: It has a five-year 98 percent survival rate. The 10-year survival rate is also 98 percent. However, given the number of individuals diagnosed, it’s the second leading cause of cancer death among U.S. males. The American Cancer Society estimates that about 34,700 men will die of the disease in 2023.
Worldwide, incidence rates vary dramatically, from 6.3 to 83.4 per 100,000 people. The highest incidence rates are in Northern and Western Europe, the Caribbean, Australia/New Zealand, North America, and Southern Africa. Asia and North Africa have the lowest rates of prostate cancer. Men of African descent are most susceptible to the illness.
Mortality rates are highest in the Caribbean, Sub-Saharan Africa, and Micronesia/Polynesia.
Trends in Diagnosis
In an editorial published by the New England Journal of Medicine, Dr. Oliver Sartor, medical director of the Tulane Cancer Center, writes that current treatment approaches are very different today from when the ProtecT clinical trial started.
The ProtecT trial relied on PSA testing, which, though still a standard test, is “no longer the norm,” writes Sartor.
“In many clinics, PSA testing is not done at all, and the legal consequences of not testing are diminished, given that guidelines now embrace patient-centric informed decision-making.”
Active Monitoring
Sartor writes, “Active monitoring as performed in the ProtecT trial should not be used today. We can do better by adding serial multiparametric MRI assessments.”
Active monitoring, also known as active surveillance, is a management approach for prostate cancer. Patients with low- or intermediate-risk disease are closely monitored with regular PSA testing, prostate exams, and sometimes repeat biopsies but don’t receive immediate active treatment such as surgery or radiation.
It aims to avoid overtreatment and its potential side effects in patients who may never develop symptoms or die from cancer while providing timely treatment if cancer shows signs of progression.
Methods used for active surveillance have evolved over the past two decades, with new evidence and guidelines informing the approach. For example, MRI and targeted biopsy have become more common in recent years, allowing for more accurate tumor size and location assessment and reducing the need for repeat biopsies. Additionally, some risk-stratification systems have been developed specifically for active surveillance patients, considering factors such as age, PSA level, and biopsy results to identify patients who may be good candidates for this approach.
Active surveillance is not appropriate for all prostate cancer patients and should be considered on a case-by-case basis.
Patients with higher-risk diseases or who are uncomfortable with close monitoring without active treatment may opt for more aggressive treatment options such as surgery or radiation.
Men with localized prostate cancer shouldn’t rush their treatment choices or react with fear, according to lead ProtecT author Dr. Freddie Hamdy of the University of Oxford. Instead, they should “consider the possible benefits and harms caused by the treatment options.”
This may apply to other cancers as well.
For some cancers, waiting to get a better understanding of the molecular profiling of a tumor can yield significant improvements in survival. Molecular profiling refers to doctors’ using information about a patient’s proteinaceous, genetic, and metabolic profile to tailor medical care to that individual’s needs. It’s important to note that, in the case of lung cancer, once profiling is complete, it’s essential to start treatment as soon as possible, as early treatment can lead to better outcomes.
4 Consequences of Overtreatment
Overtreatment can include aggressive treatments, such as surgeries and chemotherapy, that may not provide significant benefits and may even be harmful to patients.
This study shows the consequences associated with overtreatment:
- Harmful side effects: Many medical treatments come with potential side effects or risks, and overtreatment can increase the likelihood of these adverse outcomes. For example, unnecessary surgeries can lead to complications, such as infections and organ damage.
- Reduced quality of care: Overtreatment can distract health care providers from focusing on essential aspects of patient care, such as preventive measures and chronic disease management.
- Financial burden: Overtreatment and rising health care costs can result in significant financial obligations for individuals, families, and society. This can be particularly challenging for uninsured and underinsured patients.
- Emotional burden: Overtreatment can be stressful for the patient and his family.
- Waste of resources: Overtreatment can lead to the overuse of medical resources, including unnecessary tests, procedures, and medications.
It’s possible to employ fewer resources while increasing overall efficiency and accuracy in prostate cancer diagnosis and management using artificial intelligence (AI) algorithms to avoid overtreatment.
The ProtecT trial findings shouldn’t be interpreted as a recommendation to forgo treatment for localized prostate cancer. Each patient’s situation is unique, and the decision to undergo treatment or active surveillance should be made in consultation with a health care provider.
Related: Androgen Deprivation Therapy: This debunked cancer treatment may give you Alzheimer’s?
.png)
Comments
Post a Comment