Early prostate cancer patients avoiding treatment
Five years ago, nearly all men with early-stage prostate cancer opted for surgery or radiation; now, nearly half are choosing no treatment at all.
The approach is called active surveillance. It means their cancers are left alone but regularly monitored to be sure they are not growing. Just 10% to 15% of earlystage prostate cancer patients were being treated by active surveillance several years ago. Now, data for the US from three independent sources consistently finds that 40% to 50% of them are making that choice.
In recent years, major research organisations have begun to recommend active surveillance, which for years had been promoted mostly by academic urologists in major medical centres, but not by urologists in private practice, who treat most men. In 2011, the National Institutes of Health held a consensus conference that concluded that it should be the preferred course for men with small and innocuous-looking tumours. Last year, the American Society of Clinical Oncology issued guidelines with the same advice.
The data includes a large new national registry estab lished by the American Urological Association involving 15,000 men nearly all treated by urologists in private practice through 2015; a national registry of 45 mostly private urology practices; and a Michigan registry of mostly private urology practices. In addition, preliminary 2016 data from the urology association indicates that the numbers are growing, with even more than 50% of patients choosing active surveillance.
Half of all men with newly-diagnosed prostate cancer have low-risk tumours, which pathologists, using a scoring system that looks at the appearance of cells under a microscope, rate as Gleason 6 or less on a commonly used scale. Their risk of dying from prostate cancer in the next 10 years is less than 1%, whether they have aggressive treatment or choose active surveillance, research shows.
