Navigation Links
Observation is safe, cost-saving in low-risk prostate cancer

BOSTON -- Many men with low-risk, localized prostate cancers can safely choose active surveillance or "watchful waiting" instead of undergoing immediate treatment and have better quality of life while reducing health care costs, according to a study by researchers at Dana-Farber Cancer Institute and Massachusetts General Hospital.

Writing in the June 18 issue of the Annals of Internal Medicine, the authors said their statistical models showed that "observation is a reasonable and, in some situations, cost-saving alternative to initial treatment" for the estimated 70 percent of men whose cancer is classified as low-risk at diagnosis.

The researchers, led by Julia Hayes, MD, a medical oncologist in the Lank Center for Genitourinary Oncology at Dana-Farber, said their findings support observation - active surveillance and watchful waiting - as a reasonable and underused option for men with low-risk disease.

"About 70 percent of men in this country have low-risk prostate cancer, and it's estimated that 60 percent of them are treated unnecessarily" with various forms of radiation or having the disease removed with radical prostatectomy surgery, said Hayes, who is also a senior scientist at MGH's Institute for Technology Assessment. A clinical trial called PIVOT reported that such men had about the same small risk of death over a 12-year period whether they underwent radical prostatectomy or simply observation.

Hayes and her co-authors created mathematical models to construct a variety of scenarios, focusing on men ages 65 or 75 at diagnosis, and including estimated costs associated with treatment and different forms of observation.

In active surveillance (AS), patient undergo blood tests for prostate specific antigen (PSA) every three months, rectal examinations every six months, and a prostate gland biopsy at one year and then every three years. If the tests find the cancer is more aggressive than originally thought, the patients begin treatment aimed at curing the disease. "This approach could also be described as deferred treatment," said Hayes.

A patient who chooses watchful waiting (WW) is observed without intensive monitoring and is given palliative treatment when the cancer becomes symptomatic.

Treatments for low-risk prostate cancer include radical prostatectomy, intensity-modulated radiation therapy (IMRT) or brachytherapy (radioactive seed implants.)

The investigators calculated the quality-adjusted life expectancy, or QALE, for the different strategies. (QALE takes into account both the years of life gained and factors that reduce quality of life, such as undergoing invasive tests, the impact of treatment and complications, and disease recurrence.) The researchers also estimated the lifetime costs of each strategy, which ranged from $18,302 for watchful waiting for men aged 75 to $48,699 for a 65-year-old patient treated with IMRT therapy.

The bottom line result was that observation was more effective and in some cases less costly than initial treatment for low-risk prostate cancers. Watchful waiting yielded 11 months additional QALE over brachytherapy the most effective treatment and 13 months additional QALE over radical prostatectomy, the least effective treatment.

Hayes acknowledged that the study made assumptions based on limited research data on these issues. Nevertheless, "it appears that active surveillance and watchful waiting are safe alternatives to initial treatment for prostate cancer based on these assumptions. But it's important to emphasize that these decisions are very much a matter of individual choice."

Study co-author Philip Kantoff, MD, director of the Lank Center for Genitourinary Oncology at Dana-Farber and a professor of medicine at Harvard Medical School, commented: "This study delineates the cost benefit of active surveillance as well as watchful waiting - the less aggressive assessment strategy.

"A previous study by Dr. Hayes and colleagues demonstrated that active surveillance is a reasonable option for men with low-risk disease and associated with a better quality of life," Kantoff added. "As non-treatment becomes a more accepted option for these patients, selecting those who require less aggressive assessment including biopsy will become important."


Contact: Teresa Herbert
Dana-Farber Cancer Institute

Related medicine news :

1. Under pressure from Medicare, hospitals hold more seniors for observation
2. Shingles Vaccine Safe, Underutilized, Study Says
3. Genetically modified T cell therapy shown to be safe, lasting in decade-long study of HIV patients
4. Safe, simple eye test may help save lives by preventing stroke
5. Virtual Colonoscopy Safe, Effective for Medicare Patients: Study
6. Dog Days of Winter: Keeping Pets Safe, Warm
7. Childhood Vaccine Schedule Is Safe, Report Says
8. Tips to Keep Kids Safe, Warm During Winter
9. Study by Allegheny General Hospital Physicians Shows Oral Immunotherapy is a Safe, Effective Alternative to Allergy Shots for Ragweed Sufferers
10. Angioplasty at hospitals without on-site cardiac surgery safe, effective
11. Gene expression test identifies low-risk thyroid nodules
Post Your Comments:
(Date:11/27/2015)... Angeles, CA (PRWEB) , ... November 27, 2015 , ... ... study carried out by the University of Toronto and the University of British Columbia ... of hospitalizations for head injuries. The article explains that part of the reason for ...
(Date:11/27/2015)... ... November 27, 2015 , ... A team of Swiss doctors ... treat it. Surviving Mesothelioma has just posted the findings on the website. Click ... analyzed the cases of 136 mesothelioma patients who were treated with chemotherapy followed by ...
(Date:11/27/2015)... ... , ... Lizzie’s Lice Pickers just announced a special promotion that will run ... purchase of lice treatment product. In addition, customers will receive a complimentary head Check ... lice is a sure way to ruin the holidays, so we encourage all of ...
(Date:11/27/2015)... ... ... MPWH, the No.1 Herpes-only dating community in the world, revealed that over 50% of its ... 3.7 billion people under the age of 50 – or 67% of the population - ... estimates of HSV-1 infection . , "The data shocks us highly!" said Michelle Li, ...
(Date:11/27/2015)... ... ... A simply groundbreaking television series, "Voices in America", which is hosted by Hollywood legend, ... that are presently affecting Americans. Dedicated to providing the world with a wide variety ... consumers focus on, one episode at a time. , In the latest installment ...
Breaking Medicine News(10 mins):
(Date:11/26/2015)... 26 november 2015 AAIPharma Services ... geplande investering aan van ten minste $15,8 ... en het mondiale hoofdkantoor in ... resulteren in extra kantoorruimte en extra capaciteit ... groeiende behoeften van de farmaceutische en biotechnologische ...
(Date:11/26/2015)... , November 26, 2015 3D bioprinting ... 2022, according to a new report by Grand View Research ... Disease (CKD) which demands kidney transplantation is expected to boost ... effective substitute for organ transplantation. --> 3D bioprinting ... 2022, according to a new report by Grand View Research ...
(Date:11/26/2015)... November 26, 2015 ... universitetssjukhus ser potential att använda SyMRI för ... för patienter med multipel skleros (MS) ... med SyntheticMR AB för att kunna använda ... sjukhuset. Med SyMRI kan man generera flera ...
Breaking Medicine Technology: