Surveillance is best option for low-risk prostate cancer patients
MedWire News: Active surveillance (AS) may be the best treatment option for low-risk prostate cancer patients as their risk for death from the disease is less than 3% after 10 years of follow-up, report Swedish researchers.
Furthermore, despite the risk for calculated cumulative prostate cancer-specific death (PCSD) being lower among patients treated with radical prostatectomy (RP) compared with those treated with AS, the absolute difference between the groups is just 1.2% after 10 years.
Pär Stattin (Umeå University Hospital) and colleagues assessed PCSD and the risk for death from competing causes in a cohort of 6849 prostate cancer patients from the National Prostate Cancer Register of Sweden Follow-up Study.
All men were aged 70 years or less, had low- or intermediate-risk disease, and were treated with either AS (n=2021) or curative therapy, including radical prostatectomy (RP; n=3399) and radiotherapy (RT; n=1429).
The median follow-up time was 8.2 years, during which time 2.9% of AS patients, 1.7% of the RP patients, and 2.8% of RT patients died of prostate cancer.
After 10 years, the overall cumulative risk for PCSD was low, at 3.6% in the AS group, 2.4% in the RP group, and 3.3% in the RT group.
Among the 2686 men with low-risk disease, defined as clinical stage T1, Gleason score 2–6, prostate-specific antigen (PSA) <10 ng/ml, the risk was lower still, at 2.4% in the AS group, 0.4% in the RP group, and 1.8% in the RT group.
Conversely, the 937 men treated with AS for intermediate-risk disease (defined as stage T2 disease, Gleason score 7, PSA ≥10 ng/ml) had more than twice the risk for PCSD compared with those with low-risk disease, at 5.2% (vs 2.4%). And this risk was significantly higher compared with the 3.4%, and 3.8% risk in the RP and RT groups, respectively, illustrating AS’s unsuitability for intermediate-risk patients.
Stattin et al report a much higher risk for death from competing causes among patients in the AS group than among patients in the RP or RT groups or RT group (17.6% vs 6.8% and 10.9%, respectively).
“Thus, patients with a short life expectancy were more often selected for surveillance than for surgery or radiotherapy,” they write in the Journal of the National Cancer Institute.
In an accompanying editorial, Siu-Long Yao (Merck Research Laboratories, Kenilworth, New Jersey, USA) and Grace Lu-Yao (University of Medicine and Dentistry of New Jersey, New Brunswick, USA) noted that in view of the likelihood of death from competing causes, “the diagnosis of prostate cancer may be the impetus necessary for these men to change the course of their future health.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Sarah Guy