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12-02-2019 | Prostate cancer | News | Article

Conservative management of low-risk prostate cancer increasing in USA

medwireNews: US patients with low-risk localized prostate cancer are increasingly being managed with active surveillance or watchful waiting, finds a database analysis.

The proportion of men managed by these conservative approaches rose from 14.5% in 2010 to 42.1% in 2015, a significant difference. The use of radical prostatectomy and radiotherapy in these men concurrently decreased significantly from 47.4% to 31.3% and from 38.0% to 26.6%, respectively.

The findings were similar for patients classed as intermediate risk, but the changes were smaller albeit still statistically significant, with active surveillance/watchful waiting rates rising from 5.8% to 9.6% and radical prostatectomy and radiotherapy rates declining from a respective 51.8% to 50.6% and 42.4% to 39.8%.

Among men with high-risk disease, the use of active surveillance/watchful waiting was comparable in 2010 and 2015, at 1.9% and 2.2%, respectively, while the rate of radical prostatectomy increased significantly from 38.0% to 42.8% and the rate of radiotherapy decreased significantly from 60.1% to 55.0%.

“Although increasing use of [active surveillance/watchful waiting] for low-risk disease has been supported by high-level evidence and guidelines since 2010, shifting management patterns toward more radical prostatectomy in higher-risk disease and away from radiotherapy does not coincide with any new level 1 evidence or guideline changes,” write Brandon Mahal (Dana-Farber Cancer Institute, Boston, Massachusetts, USA) and co-authors in a research letter to JAMA.

And they conclude: “The potential downstream effects of efforts to increase [active surveillance/watchful waiting] for men with low-risk disease on management of other risk groups requires further examination.”

The study included data from the custom Surveillance, Epidemiology, and End Results Prostate Active Surveillance/Watchful Waiting database on 164,760 men with available information regarding the management strategy of localized prostate cancer diagnosed between 2010 and 2015.

By Shreeya Nanda

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

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