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05-05-2013 | Prostate cancer | Article

Active surveillance encouraged for very-low-risk prostate cancer in under 55s


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medwireNews: A study of US servicemen shows that, despite being eligible for active surveillance, the overwhelming majority of young men diagnosed with very-low-risk prostate cancer opt for immediate treatment.

The authors say that these men could be losing out on the benefits of active surveillance, which could include decreased health costs, greater quality of life, and the delay or potential forgoing of treatment.

Among 174 men aged 55 years and under with prostate-specific androgen (PSA) screen-detected cancer, 81 (47%) had very-low-risk disease, as defined by the Epstein criteria (stage cT1c, PSA density <0.15 ng/mL per g, Gleason score ≤6 [no pattern 4], ≤2 positive biopsy cores with <50% tumor involvement).

Of these men, 78 (96%) opted for curative therapy by radical prostatectomy or radiation within 4 months of diagnosis. Among 57 patients who underwent radical prostatectomy and had complete pathologic examination results, eight (14%) were upgraded or upstaged, while 49 (86%) had favorable pathology.

"Thus, at least with the benefits of hindsight, this sizable subset of men with very-low-risk prostate cancer with corresponding favourable pathology may benefit from alternatives to prompt therapy," write authors Douglas Boyd (University of Texas MD Anderson Cancer Center, Houston) and colleagues in BJU International.

However, they note that there are many reasons why such men opt for immediate treatment. For example, a diagnosis of cancer can evoke a reflexive decision for treatment because of the fear associated with the disease, and men may also overestimate the benefits of treatment.

Additionally, physicians themselves may be reluctant to recommend young men for active surveillance through fear of a higher rate of progression over time. The authors also add that there are no definitive criteria for favorable disease, and several issues remain unclear, such as whether young men are less likely to have organ-confined disease than older men, and whether their tumors are likely to be upstaged or upgraded at radical prostatectomy.

"Toward increasing participation in [active surveillance], our work emphasises the need for well-designed outcome studies that demonstrate the viability of [active surveillance] in this patient population," say Boyd and colleagues.

They add that there is also a need for "new biomolecular markers, to increase the accuracy of predicting which tumours carry favourable pathology, and for behavioural science studies, to identify psychosocial factors associated with treatment decision-making."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Kirsty Oswald, medwireNews Reporter

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