Prostate cancer: Most men can avoid or delay harsh treatment, long-term study confirms

CNN
—

New results from a long-running UK study show that most men diagnosed with prostate cancer can delay or avoid harsh treatment without compromising their chances of survival.

Men in the study who worked with their doctors to pay attention to low- to moderate-risk prostate tumors – a strategy called surveillance or active monitoring – significantly reduced the risk of life-changing complications such as incontinence and erectile dysfunction. . However, they were no more likely to die of cancer than men who had surgery to remove the prostate or had hormone-blocking drugs or radiation therapy.

“The good news is that if you are diagnosed with prostate cancer, don’t panic and take your time making decisions,” said Freddy Hamdi, Ph.D., lead author of the study and professor of surgery and urology. said. Oxford University.

Other experts not involved in the study agreed that the study was reassuring for men diagnosed with prostate cancer and their doctors.

Dr. Bruce Trock, professor of urology, epidemiology and oncology at Johns Hopkins University, said:

This finding does not apply to men with prostate cancer who are laboratory-assessed to be high-risk and high-grade. These aggressive cancers, which account for about 15% of all prostate cancer diagnoses, still require prompt treatment, he said.

But for others, the study adds to growing evidence that prostate cancer surveillance is often the right thing to do.

“What I learned from this is the safety of active patient monitoring,” said Samuel Haywood, Ph.D., a urological oncologist at the Cleveland Clinic in Ohio.

The results of the study were presented Saturday at the European Urological Association Annual Meeting in Milan, Italy. Two of her studies on this data were also published in the New England Journal of Medicine and his NEJM Evidence in related journals.

prostate cancer is second most The cancer behind non-melanoma skin cancers in men in the United States.According to the National Cancer Institute, approximately 11% (1 in 9) American men will be diagnosed with prostate cancer during their lifetime. and overall about 2.5% (1 in 41) die from prostate cancer. Approximately $10 billion is spent annually in the United States to treat prostate cancer.

Most prostate cancers grow very slowly. It usually takes at least 10 years for a tumor confined to the prostate to cause significant symptoms.

Conducted over 20 years, this study confirms what many doctors and researchers have realized in the meantime. Most prostate cancers are detected by blood tests that measure levels of a protein called prostate-specific antigen. PSA does not cause lifelong harm to men and does not require treatment.

Oliver Sartor, M.D., medical director of Tulane Cancer Center, said men should understand that much has changed over time and that doctors have improved their approach to diagnosis since the study began in 1999. said.

“I want to make it clear that the way these patients are screened, biopsied and randomized is very different from the way these same patients are screened, biopsied and randomized today. I wanted to do it.I am involved in research.

He said the men included in the study had early stage cancer and most were at low risk.

Doctors now have more tools, including MRI images and genetic tests, to help guide treatment and minimize overdiagnosis, he says.

The study authors said they reassessed patients using the latest methods for grading prostate cancer to allay concerns that their results may not be relevant to people today. Approximately one-third of patients would have had intermediate- or high-risk disease by these criteria, but this did not change the conclusions.

When the study began in 1999, regular PSA screening for men was the norm. Many doctors recommend an annual PSA test for men over the age of 50.

PSA test is sensitive but not specificCancer can raise PSA levels, but so can infections, sexual activity, and bicycling. Elevated PSA tests require more evaluation, including imaging studies and biopsies to identify the cause. Most of the time all that follow up just isn’t worth it.

“It’s generally thought that only about 30% of people with high PSA actually get cancer, and most people with cancer don’t need treatment,” Sartor said.

over the years, research and modeling It has been shown that using regular PSA tests to screen for prostate cancer may do more harm than good.

By some estimates, 84% of men with prostate cancer identified through routine screening are not fatal before the cancer dies from other causes, thus benefiting even if the cancer is detected. have not received

Other studies estimate that 1 to 2 in 5 men diagnosed with prostate cancer are overtreated. The harms of prostate cancer overtreatment are well documented and include incontinence, erectile dysfunction, loss of sexual potency, anxiety and depression.

In 2012, the influential US Preventive Services Task Force gave advice to healthy men. not take a PSA test It states that the harms of screening as part of routine checkups outweigh the benefits.

Now the Task Force is choosing to do more individualized approach, says men aged 55 to 69 should decide to have regular PSA tests after careful consideration of the risks and benefits with their physicians. They do not recommend PSA-based screening for men over the age of 70.

The American Cancer Society Endorses Much same approachrecommends that men at average risk start discussing the risks and benefits with their doctor from age 50.

The trial has followed more than 1,600 men diagnosed with prostate cancer in the UK between 1999 and 2009. All men had cancer that had not metastasized or spread to other parts of the body.

Men were randomly assigned to one of three groups when they entered. Radiation therapy that uses hormone-blocking drugs and radiation to shrink tumors. Prostatectomy, or surgery to remove the prostate.

Men assigned monitoring were allowed to change groups during the study if their cancer progressed to the point where they needed more aggressive treatment.

Most men have now been followed for about 15 years, and the latest analysis of the data allowed researchers to obtain follow-up information for 98% of the participants.

By 2020, 45 men (approximately 3% of participants) had died from prostate cancer. There was no significant difference in death from prostate cancer among the three groups.

Men in the active surveillance group were more likely to have their cancer progress and more likely to have their cancer metastasize compared to the other groups.About 9 of the men in the active surveillance group % confirmed cancer metastasis compared to 5% in the other two groups.

Trock points out that even if it didn’t affect their overall survival, the spread of cancer wasn’t a trivial consequence. may require aggressive treatment.

Active surveillance has provided important advantages over surgery and radiotherapy.

When they followed men for 12 years, the researchers found that between one in four and one in five men who had prostate surgery needed to wear at least one pad a day to prevent urine leakage. The rate was twice that of other groups, said Dr Jenny Donovan of the University of Bristol.

Sexual function was also affected. It is natural for men to decline in sexual function with age, and by the end of the study, nearly all men reported declines in sexual function, although the pattern of decline varied with prostate cancer treatment. she said.

“Men who undergo surgery experience early hypogonadism followed by hypogonadism. Aggressive watch groups slowly decline over time.

Donovan said that when you present the data to doctors, they will point out how much has changed since the study began.

“Some people say, ‘Okay, but we’ve got all these new technologies and new treatments: intensity-modulated radiation therapy, brachytherapy, robot-assisted prostate surgery.’ Other studies have shown that the effects on these functional outcomes are very similar to those seen in our study.

Both Donovan and Hamby feel that the conclusions of this study deserve careful consideration by men and their physicians when considering treatment decisions.

“We hope that clinicians will use these numbers generated in these papers and share them with men so that men newly diagnosed with localized prostate cancer can make real-world assessments of these trade-offs.” I hope so,” Donovan said.