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

ught, 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 assess
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Contact: Teresa Herbert
teresa_herbert@dfci.harvard.edu
617-632-4090
Dana-Farber Cancer Institute
Source:Eurekalert

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