Navigation Links
Observation is safe, cost-saving in low-risk prostate cancer
Date:6/17/2013

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
teresa_herbert@dfci.harvard.edu
617-632-4090
Dana-Farber Cancer Institute
Source:Eurekalert

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:
*Name:
*Comment:
*Email:
(Date:7/26/2017)... ... ... Six greater Bay Area roller derby leagues are partnering with Brown Paper Tickets and the ... of blood drives in California, beginning July 29. Make ‘Em Bleed roller derby blood drives ... to have helped to save up to 2700 lives. , “The Make ‘Em Bleed blood ...
(Date:7/26/2017)... ... July 26, 2017 , ... ... (ISPE) will host its 2017 Process Validation and Process Validation Statistics ... comprehensive solutions to process validation lifecycle challenges faced by process validation professionals ...
(Date:7/26/2017)... ... July 26, 2017 , ... A global ... in Jupiter. The state of the art center will provide advanced surgical ... a goal of providing heart patients longer lives. , North American Veterinary Heart ...
(Date:7/26/2017)... , ... July 26, 2017 , ... ... innovative specialty pharmacies, has released an updated version of the HCV Treatment Path ... for treating chronic hepatitis C virus (HCV) infection. All of the latest HCV ...
(Date:7/25/2017)... (PRWEB) , ... July 25, 2017 , ... ... to announce the launch of their partnership to provide the Pharmacist eCare ... first pharmacy-focused platform in the country with the ability to develop the Pharmacist ...
Breaking Medicine News(10 mins):
(Date:7/21/2017)... EDMONTON, Alberta , July 21, 2017 ... the University of Alberta in Edmonton, ... Nature,s partner journal, Schizophrenia 1 , demonstrating that ... of schizophrenia with 74% accuracy. This retrospective analysis ... specific symptoms in schizophrenia patients with significant correlation, ...
(Date:7/20/2017)... PAUL, Minn. , July 20, 2017  Prime Therapeutics ... Jonathan Gavras , M.D., following today,s Institute for Clinical ... report on the effectiveness and value of abuse-deterrent ... manager on the policy roundtable at the meeting. ... is not a material cost benefit to the use of ...
(Date:7/14/2017)... , July 14, 2017 Endo International plc (NASDAQ: ... Tuesday, August 8, 2017.  Members of its senior management team will ... open at 8:30 a.m. ET. The dial-in number ... 497-0462, International (678) 509-7598, and the passcode is 45397076. Please dial ... A replay of the call will ...
Breaking Medicine Technology: