Keep a sharp eye on prostate ca to avoid treatment

A strategy of active surveillance is a feasible approach to managing men with low-risk, early Prostate cancer, and may help many men appropriately avoid radical treatment for their cancer, British researchers suggest.

Prostate cancer is the only human cancer which is curable but which commonly does not need to be cured, researchers say. The challenge of managing early prostate cancer is to separate patients with clinically important cancers from those whose "disease" is unlikely to ever become clinically important.

The goal of active surveillance is to individualize treatment for prostate cancer by selecting only those men with significant cancers for radical curative treatment. With this approach men are closely monitored using prostate specific antigen (PSA) levels and curative treatment is undertaken only when PSA levels rise.

Active surveillance differs from so-called "watchful waiting" in which men are observed and undergo palliative treatment only when they experience symptoms suggestive of disease progression.

In their study, Dr. Chris C. Parker and colleagues from The Royal Marsden NHS Trust in Surrey, followed 80 patients with early prostate cancer. Surveillance included serial PSA testing and digital rectal exams every 3 to 6 months for the first 2 years then every 6 months thereafter.

After roughly 42 months, 64 men were still being followed by active surveillance, while 11 underwent radical treatment and 5 had died. None of the deaths were due to Prostate cancer and there was no evidence that the prostate cancer had spread to other organs.

The investigators note that the median PSA doubling time - a measure of tumor activity - in the group was a full 12 years, which "suggests an indolent course of disease in most patients."

The team also evaluated outcomes for 32 men with localized prostate cancer who were considered unsuitable for radical treatment and who underwent watchful waiting. They also were followed with serial PSA tests and digital rectal exams every 6 months.

In the watchful waiting group, 20 continued to be watched while 8 were treated with hormone therapy and 4 died, one from metastatic cancer.

"While the long-term prostate cancer mortality associated with (active surveillance) in young, fit men with favorable-risk early prostate cancer is unknown, in the worst possible case it will be as good as that associated with (watchful waiting) in such patients," the authors conclude.

SOURCE: BJU International May 2005.