Panel endorses active monitoring and delay of treatment for low-risk prostate cancer
For men diagnosed with localized, low-risk prostate cancer, a strategy of close monitoring and delayed treatment may be a better option than immediate surgery or radiation therapy.
Balintfy: An independent panel convened by the NIH has concluded that patients with low-risk prostate cancer should be offered the option of active surveillance, meaning observation with intent to cure.
Ganz: We feel confident that in the very low-risk patients that this is a reasonable thing to offer men when they are being told that they have this diagnosis
Balintfy: Dr. Patricia A. Ganz is the panel chairperson, and director of the Division of Cancer Prevention and Control Research at the Jonsson Comprehensive Cancer Center at the University of California in Los Angeles. She explains that more men are being identified as having very low-risk, slow-growing prostate cancer who may not choose surgery or radiation at the time of their diagnosis, but want to be followed.
Ganz: And if at some time their disease pattern changes, they would like to then go ahead with active treatment at that time.
Balintfy: However, approximately 90 percent of patients receive immediate treatment, such as surgery or radiation therapy. For many of these patients, treatment has serious short- and long-term side effects, such as diminished sexual function and loss of urinary control. And the immediate treatments in these cases do not have clear benefits, such as improved survival. Dr. Ganz says that by reviewing current scientific data, the panel learned about this substantial part of the prostate cancer population.
Ganz: Men may be getting treatments that are not necessarily going to change their life course and their survival and lead to significant morbidities such as sexual and urinary problems that are very common after surgery or bowel and urinary and sexual problems that can occur with radiation, and that men will have problems with this as a result even though the cancer may not have ever caused them troubles. So that by taking an approach that delays or perhaps never requires that kind of intervention, they may be spared that.
Balintfy: Prostate cancer is common in men in the United States. Estimates for 2011 are that approximately 240,000 men will be newly diagnosed with prostate cancer and 33,000 will die of the disease. More than half of these cancers are confined to the prostate, not aggressive at diagnosis, and unlikely to become life-threatening. But Dr. Ganz points out that a big challenge is the word ‘cancer’ itself.
Ganz: If you are told you have cancer and the part of the body that's involved can be removed or treated effectively with some local treatment, you want to have it taken care of immediately. In fact, you would have liked to have had it done yesterday. And to get patients and doctors to think about delaying and not doing something as potentially “the best” or an equivalent strategy is hard to accept.
Balintfy: Yet, Dr. Ganz feels because of the opportunity to identify very low-risk patients, the option should be presented.
Ganz: We can feel confident about having a delay in therapy or no therapy at all that may emerge because the natural history of the cancer will declare itself to be either one that progresses or stays quiet.
Balintfy: Dr. Ganz also points out that there is need for more research.
Ganz: It's a true missed opportunity if the many thousands of men and literally over 200,000 men per year who are diagnosed with this disease do not in some way participate in research or have the opportunity to participate in research so we can learn more about who needs more intensive or less intensive treatment.
Balintfy: For more information on the panel's findings, visit the website consensus.nih.gov. And for more information on prostate cancer research and treatments, visit www.cancer.gov. This is Joe Balintfy, at the NIH in Bethesda, Maryland.
About This Audio Report
Reporter: Joe Balintfy
Sound Bite: Dr. Patricia A. Ganz
Topic: prostate, prostate cancer, cancer, active surveillance, observation, low-risk, cancer treatment, surgery, radiation, therapy