A Third Option for Prostate Cancer Treatment: Active Surveillance

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With the current controversy on prostate cancer screening and PSA (prostate-specific antigen) testing, a trend appears to be developing away from aggressive surgical treatment for early-stage localized prostate cancer.

Today, most urologists and radiation oncologists regard watchful waiting or active surveillance as an effective strategy for managing low-risk prostate cancer. However, whether physicians recommend active surveillance to their patients varies dramatically depending on patient age, tumor size, and prostate-specific antigen (PSA) levels.

study published in the Journal of Clinical Oncology on February 20, 2018, showed that almost 90 percent of radiation oncologists and about 83 percent of urologists recommended watchful waiting for men in their seventies with smaller tumors, but only about 4 percent of radiation oncologists and 5 percent of urologists recommended active surveillance for men in their fifties with larger tumors.

Researchers Albert Kim, Robert Abouassaly, and Simon Kim assessed the attitudes and treatment recommendations for low-risk prostate cancer from a national survey of prostate cancer specialists. Between January and July 2017, 940 physicians in the United States who are active in the treatment of prostate cancer were surveyed. All of the physicians were asked how they view active surveillance as well as what their treatment recommendations were for patients diagnosed with low-risk prostate cancer. Of the 691 physicians who responded to the survey, 92 percent of urologists and roughly 87 percent of radiation oncologists thought active surveillance was effective for low-risk prostate cancer.

In spite of these findings, active surveillance or watchful waiting still lags behind aggressive treatment, which would include surgery and radiation therapy. Part of the explanation for the higher rates of surgery and radiation therapy rather than active surveillance in the treatment recommendation for younger low-risk prostate cancer patients may also reflect patient preferences. Nearly half of the radiation oncologists surveyed reported that active surveillance “increases patient anxiety.”

Despite the reluctance of some physicians and patients to trust a newer, less aggressive strategy, this current study suggests a positive trend toward active surveillance. Surgeons and radiation oncologists agree that this approach is entirely safe and does not decrease the survival rate from early-stage prostate cancer.

Dudley Seth Danoff, MD, FACS, is president and founder of the Cedars-Sinai Tower Urology Medical Group in Los Angeles, a Diplomate of the American Board of Urology, a Fellow of the American College of Surgeons, and the author of two books on men’s health, including The Ultimate Guide to Male Sexual Health