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

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

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