More American men saying no to surgery for low-risk prostate cancer

The numbers tell the story – in just five years, more U.S. men diagnosed with low-risk prostate cancer, are choosing active surveillance over surgery for treating their disease.  Back in 2010, 14 percent of men with low-risk prostate cancer opted for active surveillance; by 2015, this number had tripled to 42 percent. This news comes from the Journal of the American Medical Association, based on government cancer database. It included information on nearly 165,000 U.S. men diagnosed with early-stage prostate cancer that was confined to the prostate gland.

Compared with high-risk or intermediate-risk prostate cancer, low-risk prostate cancer tends to grow very slowly or not at all which is why active surveillance can be considered as an alternative to other treatments such as surgery or radiation.

Other findings from this research showed among men with low-risk cancer, the percentage receiving surgery as their initial treatment dropped from about 47 percent in 2010, to 31 percent in 2015. The rate of radiation therapy declined from 38 percent to just below 27 percent.

What is active surveillance?

Active surveillance is a viable method of monitoring low-grade, early-stage prostate cancer that is considered to be very slow growing and not likely to spread.  Active surveillance has increasingly emerged as a viable option for men who decide not to undergo immediate treatment (surgery or radiation therapy) for prostate cancer.

Active surveillance will be considered by a physician to monitor a man’s prostate cancer if:

·      The tumor is small and limited to the prostate

·      The tumor is considered to be slow-growing and unlikely to spread (metastasize) or that the man’s chances of dying from the cancer is unlikely.

·      A man is elderly and is more likely to die from another cause

·      A man has other serious health problems

The term active surveillance is a means of monitoring the cancer closely with the goal to allow a man to have the highest quality of life while delaying or even completely avoiding invasive treatments.  Active surveillance is based on the concept that low-risk prostate cancer is unlikely to harm a man or reduce life expectancy. Over 30% of men have prostate cancers that are so slow growing making active surveillance a better choice than immediate local treatment. Active surveillance is not to be confused as ‘no treatment,” but rather a strategy to treat a man only if and when his cancer warrants treatment.

Most physicians’ active surveillance programs involve seeing a man with prostate cancer every 6 months or yearly to keep a close eye on his disease.  At these visits, a man will undergo a prostate specific antigen (PSA) blood test and a digital rectal exam (DRE).  Sometimes the physician may want to do periodic biopsies or MRIs of the prostate if he has concerns of it growing.   

What do experts think?

This recently released research has garnered favor among many experts in the field of urology and prostate cancer. The shift is turning towards embracing active surveillance as a good option for men with slow-growing prostate cancer.  It is highly recommended for any man diagnosed with low-risk prostate cancer to discuss in detail with their doctor about the option of using active surveillance to see if it is appropriate for them.

Part of the concern over surgery for low-risk prostate cancer has been with possible side effects, such as urinary incontinence and sexual dysfunction. The point of active surveillance is to help men with low-risk prostate cancer avoid unnecessary treatment side effects from surgery or radiation.

There will always be some men who want the cancer out of them as soon as possible and will choose surgery over active surveillance. But many other men will and have welcomed the option of choosing active surveillance to avoid possible surgical complications.

Men living in the U.S. have a one in nine chance of being diagnosed with prostate cancer, according to the American Cancer Society.  However, because this cancer is often slow-growing, it may never progress significantly.  It is not uncommon for men who live long enough to have a low-risk prostate cancer but ultimately die from something else.

For the year 2019, the American Cancer Society estimates that in the U.S., about 174,650 new cases of prostate cancer will be diagnosed and about 31,620 men will die from the disease.

Bottom line 

This new study points out the fact that the best ways to treat certain types of prostate cancer are evolving. Men diagnosed with this disease should be carefully analyzed to determine the best treatment method. What’s right for one man may be different for another. Depending on the type, location and aggressiveness of a man’s prostate cancer, surgery is still an option. But with more scientific-backed evidence and more doctors’ acceptance of active surveillance, men with slow-growing prostate cancer can be managed in a less aggressive manner unless it changes over time in which more aggressive treatment may be required.