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Active Surveillance of Prostate Cancer may be Best Strategy for Quality of Life

Kathleen Blanchard's picture
Prostate cancer research and finger length

In a comparison study of men with low risk prostate cancer, researchers found the best strategy for quality of life may be active surveillance versus other treatments such as prostatectomy, radiation therapy or radium seed implants. The researchers used a simulation model that incorporated outcomes from previous studies and reviews to find little difference in chances of death from the disease between the two strategies.

The researchers say, "The quality-of-life advantage associated with active surveillance is robust in this model of treatment alternatives for men with clinically localized, low-risk prostate cancer”, but they also note much depends on individual preference about how prostate cancer is treated.

Sixty Percent of Prostate Cancers may not Require Treatment

The study authors note 192,000 men in the U.S. were diagnosed with prostate cancer in 2009. Of those, 70 percent would have been classified with low-risk disease, meaning the cancer is localized and unlikely to spread. Even though sixty percent of men may not require treatment, 90 percent would have received surgery or radiation that leads to at least one adverse effect that can interfere with quality of life.

The idea of active surveillance of prostate cancer includes delaying treatment unless it is needed or the patient chooses treatment. Methods of watching include PSA testing, biopsies and digital rectal exams.

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The analysis, published in the Journal of the American Medical Association, found that for men over age 65, active surveillance and radiation therapy if needed, provided higher QUALE (Quality Adjusted Life Expectancy) and 11.07 years quality adjusted life years (QALY).

The authors write, "Brachytherapy and IMRT [intensity modulated radiation therapy] were less effective at 10.57 and 10.51 QALYs, respectively. Radical prostatectomy was the least effective treatment, yielding 10.23 QALYs. The difference between the most and least effective initial treatment was 0.34 QALYs, or 4.1 months of QALE. In contrast, active surveillance provided 6.0 additional months of QALE compared with brachytherapy [radium seed implants], the most effective initial treatment."

The lifetime relative risk of dying from prostate cancer was 0.6 percent for treatment versus surveillance. The authors say treatment should ultimately be based on individual preference.

The study model showed watching prostate cancer improves quality of life for men with low risk disease from fewer adverse events associated with prostate resection, radiation and brachytherapy that could include erectile dysfunction and urinary incontinence. The researchers say patients should be assisted through discussion of risk and benefits of each, and concluded "active surveillance is a reasonable approach to low-risk prostate cancer based on QALE compared with initial treatment."

JAMA. 2010;304[21]:2373-2380