Long-term study confirms that most men with prostate cancer can delay or avoid harsh treatments. According to new findings from a long-running study in the United Kingdom, most men with prostate cancer can delay or avoid harsh treatments without harming their chances of survival.
Men in the study who collaborated with their physicians to closely monitor their low- to intermediate-risk prostate tumors (a method known as surveillance or active monitoring) reduced their risk of life-altering complications such as incontinence and erectile dysfunction that can result from aggressive treatment for the disease; however, they did not have a higher risk of dying from their cancers than men who underwent prostate surgery or were treated with hormone blockers and radiation.
Lead study author Dr. Freddie Hamdy, a professor of surgery and urology at the University of Oxford, stated, “The good news is that if you’re diagnosed with prostate cancer, don’t panic, and take your time to make a decision” regarding how to proceed.
Other experts who were not part of the study agreed that the study provided men with prostate cancer diagnoses and their doctors with reassurance.
According to Dr. Bruce Trock, a professor of urology, epidemiology, and oncology at Johns Hopkins University, “you can delay or avoid treatment without missing the chance to cure in a large fraction of patients when men are carefully evaluated and their risk assessed.”
Men with high-risk and high-grade prostate cancers, as determined by testing, are not affected by the findings. According to Hamdy, these aggressive cancers still require prompt treatment and account for approximately 15% of all prostate cancer diagnoses.
However, the study adds to the growing body of evidence that suggests surveillance of prostate cancers is frequently the best course of action for others.
Dr. Samuel Haywood, a urologic oncologist at the Cleveland Clinic in Ohio who reviewed the study but was not involved in the research, stated, “What I take away from this is the safety of doing active monitoring in patients.” Haywood was not involved in the research.
On Saturday, the study’s findings were presented at the annual conference of the European Association of Urology in Milan, Italy. In addition, two studies based on the data were published in the New England Journal of Medicine and NEJM Evidence, a companion journal.
Prostate cancer is the second most common cancer among men in the United States, after non-melanoma skin cancers. It is typically a low-risk cancer. The National Cancer Institute estimates that one in nine American men will be diagnosed with prostate cancer in their lifetime and that 2.5 percent, or one in 41, will die from the disease. Prostate cancer treatment costs approximately $10 billion annually in the United States.
The majority of prostate cancers develop slowly. A prostate-confined tumor typically takes at least ten years to manifest significant symptoms.
Over the course of the study’s more than two decades of operation, many doctors and researchers have come to the following conclusion: The majority of prostate cancers detected by blood tests measuring levels of a protein known as prostate-specific antigen, or PSA, will not cause men any harm over their lifetimes and do not necessitate treatment.
Dr. Oliver Sartor, clinical head of the Tulane Malignant growth Place, said men ought to comprehend that a great deal has changed after some time, and specialists have refined their way to deal with conclusion since the review started in 1999.
Sartor, who wrote an editorial about the study but was not involved in the research, stated, “I wanted to make clear that the way these patients are screened, biopsied, and randomized is very, very different from how these same patients might be screened, biopsied, and randomized today.”
According to him, the majority of the men in the study were low-risk and in the early stages of their cancer.
According to presently, he, specialists have more apparatuses, including X-ray imaging and hereditary tests that can assist with directing treatment and limit overdiagnosis.
The review creators express that to alleviate worries that their outcomes probably won’t be applicable to individuals today, they rethought their patients involving present day strategies for evaluating prostate diseases. The findings remained unchanged despite the fact that, according to those criteria, approximately one third of their patients would have intermediate or high-risk disease.
When less treatment is better care: When the study started in 1999, men were typically screened for PSA on a regular basis. PSA tests were encouraged by many doctors on an annual basis for male patients over 50.
PSA tests are not specific, but they are sensitive. PSA levels can be raised by cancer as well as by infections, sexual activity, and even riding a bicycle. In order to determine the cause, elevated PSA tests necessitate additional evaluation, which may include imaging and biopsies. All of that follow-up just doesn’t make sense most of the time.
According to Sartor, “it is generally thought that only about 30% of the people with an elevated PSA will actually have cancer, and of those who do have cancer, the majority don’t need to be treated.”
Studies and modeling over the years have demonstrated that routine PSA tests to screen for prostate cancer can cause more harm than good.
According to some estimates, as many as 84% of men who have been diagnosed with prostate cancer through routine screening do not benefit from having the cancer detected because it would not be fatal before they died of other causes.
According to other studies, between one and two men diagnosed with prostate cancer receive excessive treatment. The damages of overtreatment for prostate malignant growth are proven and factual and incorporate incontinence, erectile brokenness and loss of sexual intensity, as well as tension and despondency.
In 2012, the influential US Preventive Services Task Force advised healthy men not to have PSA tests as part of their regular checkups, stating that screening had more negative effects than it had positive ones.
The task force now takes a more individualized approach, stating that men between the ages of 55 and 69 should carefully weigh the risks and benefits with their doctor before opting for PSA testing on a regular basis. For men over 70, they advise against PSA-based screening.
The same approach is supported by the American Cancer Society, which advises men with average risk to discuss the risks and benefits with their doctor as early as age 50.
The trial followed over 1,600 men who were diagnosed with prostate cancer in the UK between 1999 and 2009, and treatment had no effect on survival. All of the men had cancers that had not spread to other parts of their bodies or metastasized.
The men were placed in one of three groups at random when they joined: regular blood tests or active monitoring to monitor their PSA levels; hormone-blocking radiation and radiotherapy were used in radiotherapy to shrink tumors. and prostate removal surgery, also known as a prostatectomy.
During the course of the study, men who were assigned monitoring could switch groups if their cancers progressed to the point where they required more aggressive treatment.
Researchers were able to obtain follow-up information on 98% of the participants for the most recent data analysis because the majority of the men have been followed for approximately 15 years.
Prostate cancer claimed the lives of 45 men, or about 3% of the participants, by the year 2020. Prostate cancer deaths did not differ significantly between the three groups.
Compared to the other groups, men in the active monitoring group were more likely to have their cancer progress and spread. In contrast to the 5% of men in the two other groups, approximately 9% of men in the active monitoring group experienced cancer metastasis.
Trock points out that a spreading cancer isn’t a trivial result, even though it didn’t affect their overall survival. At that stage, aggressive treatments may be necessary to manage the pain.
Compared to surgery or radiation, active surveillance does have significant advantages.
Over a 12-year period, the researchers followed the men and discovered that one to one in four to one in five men who had prostate surgery required daily pad wear to prevent urine leaks. According to Dr. Jenny Donovan of the University of Bristol, who was in charge of the study on patient-reported outcomes following treatment, that rate was twice as high as that of the other groups.
Additionally, sexual function was harmed. She stated that although men’s patterns of decline varied depending on their prostate cancer treatment, it is normal for men’s sexual function to decline with age. By the study’s conclusion, nearly all of the men had reported low sexual function.
Early on, men who have surgery experience low sexual function, which persists. According to Donovan, the men in the active monitoring group experience a gradual decline in sexual function over time, whereas the men in the radiotherapy group experience a drop in sexual function followed by some recovery.
According to Donovan, when she presents her data to medical professionals, they emphasize how much has changed since the study began.
She stated, “Some people would say, ‘OK, yeah, but we’ve got all these new technologies now, new treatments,'” which included robot-assisted prostate surgeries, intensity-modulated radiation therapy, and brachytherapy. However, “actually, other studies have shown that the effects on these functional outcomes are very similar to the effects that we see in our study.”
Donovan and Hamby agree that men and their doctors should still carefully consider the study’s findings when making treatment decisions.
Donovan stated, “What we hope that clinicians will do is use these figures that we’ve produced in these papers and share them with the men so that newly diagnosed men with localized prostate cancer can really assess those tradeoffs.” “We hope that clinicians will use these figures and share them with the men.”
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