Prostate cancer patients with a low-risk form of the disease may be better off if they avoid surgery or radiation treatment and instead participate in active surveillance, concluded a study published in the Journal of the American Medical Association (JAMA). During active surveillance, certain exams and tests are conducted on a regular schedule to monitor the progress of the cancer.
The study compared the side effects and outcomes of surgery or radiation for localized prostate cancer with active surveillance in order to help men with prostate cancer choose the best treatment option. Some researchers consider surgery to be the best option. Previous studies indicate it has better long-term cancer outcomes than radiation for higher-risk cancers. However, it has been linked to more sexual and urinary side effects than radiation.
In this new study, more than 99 percent of patients had an excellent three-year prostate cancer survival rate no matter which option they chose: surgery, radiation, or active surveillance.
“It is best to avoid treatment if you have a prostate cancer that is safe to observe,” said the study’s lead author Daniel Barocas, M.D., MPH, associate professor of Urologic Surgery at Vanderbilt University Medical Center. “This is why most doctors recommend active surveillance for low-risk cancers.”
Barocas pointed out that the study did not investigate whether the mortality rate of prostate cancer patients who underwent active surveillance is less compared to other treatment approaches. To determine this, researchers would have to follow the men for 10 or more years because prostate cancer is usually slow growing.
“This study shows that, despite technological advances in the treatment of prostate cancer, both surgery and radiation still have a negative effect on quality of life,” concluded co-authors David Penson, M.D., MPH, Paul V. Hamilton, M.D., and Virginia E. Howd Professor of Urologic Oncology and professor and chair of the Department of Urologic Surgery. “Certainly, if a man has low-risk prostate cancer, he should seriously be considering active surveillance as a reasonable way to go.”
Active Surveillance Is The “Reasonable Way To Go”
The study also found that three years after treatment, erectile dysfunction and urinary incontinence occurred more often in men treated with surgery compared with radiation. However, the increase in sexual dysfunction only occurred in men whose sexual function was excellent at the study’s start.
“Urinary incontinence was reported as a moderate or big problem in 14 percent of men three years after surgery compared to 5 percent of men who had radiation,” Barocas said.
“Men who had radiation reported more problems with bowel function and hormone side effects compared to men who had surgery, but these differences were only seen within the first year following treatment,” he said.
Another finding of the study was that fewer urinary symptoms, like weak urine stream or urinary frequency, occurred after surgery, compared to active surveillance. However, surgery was linked to worse urinary incontinence compared to radiation and active surveillance.
Source: Barocas DA, Alvarez J, Resnick MJ, Koyama T, Hoffman KE, Tyson MD, Conwill R, McCollum D, Cooperberg MR, Goodman M, Greenfield S, Hamilton AS, Hashibe M, Kaplan SH, Paddock LE, Stroup AM, Wu XC, Penson DF. Association Between Radiation Therapy, Surgery, or Observation for Localized Prostate Cancer and Patient-Reported Outcomes After 3 Years. JAMA. 2017 Mar 21;317(11):1126-40. doi: 10.1001/jama.2017.1704.