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Active monitoring viable option for early prostate cancer diagnosis

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Men who received active monitoring following an early prostate cancer diagnosis have the same 10-year mortality rate as those who underwent surgery or received radiation for treatment, according to a study published in The New England Journal of Medicine (NEJM).

The study, published on October 13, 2016, featured 1,643 men between the ages of 50 to 69 years old. The men were randomly assigned to receive active monitoring, radical prostatectomy (a surgical procedure to remove all or parts of the prostate) or radiotherapy (radiation). Active monitoring involves checking prostate-specific antigen levels every three months for the first year and then every six to 12 months thereafter.

Of 1,643 men, who received active monitoring, surgery or radiation after early prostate cancer diagnosis, 14 died within 10-years

After following up with the participants 10 years later, researchers found that mortality from prostate cancer was low, regardless of the method of treatment. Fourteen men, or about 1 percent, died within the 10-year follow-up window.

The study is helpful for men who were either recently diagnosed with early prostate cancer or for those worried about treatment, according to Shirisha Reddy, a medical director at Aetna.

“It’s a great thing because it tells patients you can just watch it and you should be fine,” Reddy said of active monitoring. “It should give patients comfort.”

Prostate cancer

Prostate cancer is the most common cancer in American men, according to the American Cancer Society. About one in seven men will be diagnosed in their lifetime and roughly six in ten cases of prostate cancer are diagnosed in men 65 and older, according to the American Cancer Society.

1 in 7 men will be diagnosed with prostate cancer in their lifetime

The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER) estimates 180,890 new cases of prostate cancer and 26,120 deaths due to the disease in 2016.

While it is the most common cancer for men in the U.S., it is also highly survivable. The five-year survival rate is 98.9 percent, according to SEER data from 2006 to 2012.

Screening recommendations vary. The general recommendation is to start exams and blood testing at age 50. Men who are African American or who have a family history of prostate cancer might need to be tested earlier.

The frequency of prostate exams for men will depend on their prostate-specific antigen levels. For example, men with high levels should receive a screening every two years or every year, according to Reddy. A primary care physician can determine how early and often prostate screening is advised for specific individuals.

Treatment

The three most common methods of treatment for prostate cancer are active monitoring, radiation and surgery.

Men who received active monitoring did not experience side effects compared to other treatment methods

While the 10-year mortality rate of each treatment was the same, surgery and radiation were associated with slowing down the spread of the cancer, according to the study.

The men who received active monitoring, however, did not experience complicated side effects from their treatment method, unlike those who received radiation or surgery.

Reddy said the type of treatment recommended by a physician depends on the severity of the cancer. If it spreads to the lymph nodes, Reddy said, surgery is likely.

“If your PSA (prostate-specific antigen) has gone up, but nothing is impacted, then it would have to be a conversation between you and your doctor,” Reddy added.

Reddy emphasized the importance of talking with your doctor when determining which treatment method is best and appropriate.

“For certain groups of patients, there is no benefit with aggressive treatment. With active monitoring, they may experience a better quality of life.”