Fewer side effects for prostate cancer with alternative approach

6 Jul 2015

Men with very low and low risk prostate cancers may be able to avoid aggressive treatment by using watchful waiting or active surveillance. This approach called expectant management could be very useful for a large number of men with localized tumors as it could spare them the debilitating side effects of the already used treatments. This is reported by a UCLA review of common practices in prostate cancer adding that these aggressive treatments are too often unnecessarily used in this patient population. 

Since the initiation of PSA screening tests, most men with prostate cancer are now diagnosed with localized, low-risk prostate tumors that are unlikely to kill them. However, nearly all of these men undergo surgery or radiation, putting them at risk for ongoing side effects such as erectile dysfunction and impaired urinary function. As many as 40 %  patients may currently be over treated, said review senior author Dr. Mark Litwin, professor and chair of UCLA Urology.

Analyzing aspects of expectant management and current protocols

This study is the most up-to-date and comprehensive review of expectant management of prostate cancer patients worldwide.

The review clearly lays out a number of aspects of expectant management for men with low-risk prostate cancer.

  • First, the UCLA team clarified the definitions of types of surveillance, making it easier for physicians and their patients to decide which is best for them.
  • Active surveillance uses repeated PSA testing and prostate biopsies to monitor for development of more aggressive disease in younger, healthier patients who might benefit from delaying treatment.
  • Watchful waiting avoids aggressive testing and watches for any physical symptoms of progressive disease. It is generally reserved for avoiding treatment altogether for older, sicker patients who will most likely die from something else.

The review describes the current surveillance protocols, and reviews the outcomes for each of these strategies in terms of cancer survival and quality of life. Additionally the review addresses the novel technologies such as prostate MRI and fusion biopsies that may prove beneficial for surveillance patients.


Strict inclusion criteria to identify the optimal candidates

"Considerable questions remain regarding both the identification of optimal candidates for surveillance, as well as understanding the ideal monitoring strategy after the initiation of observational protocols," said Dr. Leonard Marks, study co-author and a professor of urology. "Using strict inclusion criteria can select a group of prostate cancer patients who would avoid the side effects of therapy while experiencing comparable survival and quality of life."

"Ultimately, the decision-making process surrounding treatment for a man with localized prostate cancer must take an individualized approach. Despite increased adoption of expectant management, active surveillance still remains broadly underused and more data will be needed to clarify the factors contributing to this finding at a population level.


Source: Science Daily
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