Navigation Links
Active surveillance for low-risk prostate cancer may offer better quality-of-life
Date:11/30/2010

This release is also available in Chinese on EurekAlert! Chinese.

In a study that compared initial treatment strategies for low-risk prostate cancer among men 65 years old, active surveillance showed higher measures on quality of life compared to an initial treatment such as radical prostatectomy, although the optimal strategy was highly dependent on individual patient preferences for surveillance or treatment, according to a study in the December 1 issue of JAMA.

In 2009, 192,000 men were diagnosed as having prostate cancer in the United States. Of these men, 70 percent will have been classified as having low-risk, clinically localized disease, and more than 90 percent will have undergone initial treatment, although up to 60 percent of men diagnosed as having prostate cancer may not require therapy. "Initial treatment choices include surgical resection [removal] or radiation therapy. The majority of men experience at least 1 adverse effect of treatment," according to background information in the article. Active surveillance is a strategy of close monitoring for carefully selected patients with low-risk prostate cancer, with the intent being to avert treatment unless disease progression occurs or a patient chooses treatment.

Julia H. Hayes, M.D., of the Dana-Farber Cancer Institute, Harvard Medical School, Boston, and colleagues examined the quality-of-life benefits and risks of active surveillance compared with initial treatment for men with low-risk, clinically localized prostate cancer. In the study, which used a simulation model, men were treated at diagnosis with brachytherapy (internal radiation therapy), intensity-modulated radiation therapy (IMRT), or radical prostatectomy or followed up by active surveillance (a strategy of close monitoring of newly diagnosed patients with certain prostate-specific antigen measurements, digital rectal examinations, and biopsies, with treatment at disease progression or patient choice). Probabilities were derived from previous studies and literature review.

The researchers found that in men 65 years old, active surveillance, with IMRT for progression, was the most effective strategy (defined as the strategy associated with the highest quality-adjusted life expectancy [QALE], producing 11.07 quality-adjusted life-years [QALYs; a higher QALY reflects a year of life in a preferred health state]). "Brachytherapy and IMRT 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, the most effective initial treatment," the authors write.

The researchers also conducted an analysis to identify how much greater the risk of prostate cancer-specific death would have to be under active surveillance compared with initial treatment for the 2 approaches to be associated with equal QALE. "For QALE to be equal, 15 percent of men undergoing active surveillance would have to die of prostate cancer as opposed to 9 percent who received initial treatment, a lifetime relative risk of death of 0.6 for initial treatment vs. surveillance."

The authors note that the QALE gains and the optimal strategy were highly dependent on individual preferences for living under active surveillance and for having been treated.

"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. This benefit reflects the deferred and substantially lower incidence of adverse effects of treatment experienced by men under active surveillance. Active surveillance is associated with significant improvements in QALE even in analyses in which the probability of dying of prostate cancer or of developing progressive disease during active surveillance is increased. However, the finding that the optimal strategy is sensitive to utility weights [weight assigned to an individual's preference for a particular health state] is evidence that the decision whether to pursue active surveillance must be individualized. Models that incorporate individual patient utilities should be developed to assist patients and their caregivers to estimate the risks and potential benefits of active surveillance before making this decision," the authors conclude.

(JAMA. 2010;304[21]:2373-2380. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Please Note: For this study, there will be multimedia content available, including the JAMA Report video, embedded and downloadable video, audio files, text, documents, and related links. This content will be available at 3 p.m. CT Tuesday, November 30 at www.digitalnewsrelease.com/?q=jama_3767.

Editorial: Active Surveillance for Prostate Cancer

Ian M. Thompson, M.D., of the University of Texas Health Science Center at San Antonio, Texas, and Laurence Klotz, M.D., of Sunnybrook Health Science Centre, Toronto, write in an accompanying editorial that for the majority of men with favorable-risk localized disease, surveillance will be an attractive option that avoids adverse effects of treatment.

"Ongoing studies to identify biomarkers that are highly specific for indolent tumorsand can effectively identify those that will not progresswill help patients and physicians to accept this approach. Concurrent advances in imaging are on the cusp of clinical use; through these techniques, noninvasive identification of prostatic lesions consistent with high-grade tumors may soon be possible along with image-directed biopsy to replace the current technique of random biopsy. Ultimately, this approach will direct toward surgery or radiation more patients for whom therapy may be beneficial and will provide reassurance to physicians and their patients with low-risk tumors that treatment may be deferred until and unless needed. Until such information is available, the study by Hayes et al gives support to active surveillance, for many men, as a viable option."

(JAMA. 2010;304[21]:2411-2412. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.


'/>"/>

Contact: Teresa Herbert
teresa_herbert@dfci.harvard.edu
617-632-5653
JAMA and Archives Journals
Source:Eurekalert

Related medicine news :

1. Embark Health Selects the Jellyvision Lab's Interactive Conversation Technology to Educate Website Visitors on Advance Directives
2. Abington Memorial Hospital's Travelers Clinic Can Protect Travelers From The Now Active Yellow Fever
3. Lumension Unveils Intelligent Application Whitelisting that Operationalizes a Proactive Endpoint Security Approach
4. New Ankle Arthritis Treatments Help Boomers Stay Active
5. Antibodies linked to cardiovascular disease increase in patients with active lupus
6. WellNet Supports HPM Institute Director in Calling for More Active Enterprise Involvement in Managing Healthcare Quality and Costs
7. LodgeNet Interactive Names Frank P. Elsenbast As Next Chief Financial Officer
8. Tahitian Noni Bioactive Beverages™ Contain Iridoids
9. Iridoids in Tahitian Noni Bioactive Beverages™ are Found to be Extremely Stable
10. Five New Tahitian Noni Bioactive Beverages™ Announced
11. Commonwealth Leverage Group and Helium Interactive Form HIE Go-To-Market Partnership
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:3/24/2017)... Orion, MI (PRWEB) , ... March 24, 2017 ... ... insurance assistance, financial planning, and related services to families and business owners across ... initiative aimed at feeding regional families struggling with financial difficulties. , The Oxford/Orion ...
(Date:3/24/2017)... ... March 24, 2017 , ... ... that they are now offering treatments for sleep apnea and TMJ at their ... Sleep apnea , specifically the obstructive type, is increasingly being treated at ...
(Date:3/24/2017)... ... March 24, 2017 , ... Gastro Health (“GH”) ( ... patients for colonoscopy at the HyGIeaCare® Center that is to be located adjacent ... , The HyGIeaCare® Prep, cleared by the U.S. Food and Drug Administration ...
(Date:3/24/2017)... ... ... “End Time GPS”: a dauntless and enlightened study of the second-coming ... the creation of published author, Wesley Gerboth, a World War II veteran, with a ... Now, at age ninety-one, he shares the Wisdom God bestowed upon him in this ...
(Date:3/23/2017)... , ... March 23, 2017 , ... In 2016 the ... estimates that there could be four million Zika-related cases in the Americas within the ... numbers of US cases reported per year skyrocketing to an estimated 329,000. Yet, Zika, ...
Breaking Medicine News(10 mins):
(Date:3/24/2017)... and PUNE, India , March 24, 2017 ... and is estimated to reach $2,614 million by 2022, Globally, registering a CAGR of ... generate the highest revenue, and is projected to dominate the market during the study ... ... Allied Market Research Logo ...
(Date:3/24/2017)... IRVINE, Calif. , March 24, 2017 ... ,the epigenetics company, and Hamilton Robotics, Inc., ... workstations, announced an ongoing collaboration that teams ... products and RNA and DNA extraction products ... has already created optimized methods for microbiomics ...
(Date:3/24/2017)... Mar. 24, 2017 Research and Markets has announced ... report to their offering. ... This report analyzes the worldwide markets for Dental Implants in US$ ... Canada , Japan , Europe ... and Rest of World. Annual estimates and forecasts are ...
Breaking Medicine Technology: