Navigation Links
Study Backs 'Active Surveillance' for Low-Risk Prostate Cancer
Date:11/30/2010

By Amanda Gardner
HealthDay Reporter

TUESDAY, Nov. 30 (HealthDay News) -- Using a computer simulation model, researchers say they've determined that relying on "active surveillance" to follow men with low-risk prostate cancer is a "reasonable approach" and alternative to immediate treatment, which can cause unwanted side effects such as incontinence and impotence.

If the tumor were to start growing again, treatment options could include intensity-modulated radiation therapy (IMRT), which uses beams of different radiation intensities to limit damage to surrounding areas of the body, the study authors said.

"The intent of this study is to show that, on average, showing average disease-recurrence probabilities, an average rate of side effects and average individual preferences, active surveillance was an option," said Dr. Julia H. Hayes, lead author of the study published in the Dec. 1 issue of the Journal of the American Medical Association.

But the computer model isn't intended to replace personal decision-making for prostate cancer patients, all of whom have vastly different comfort levels when it comes to how they handle their diagnosis of cancer, the researchers said.

Still, the model might serve as a jumping-off point for doctor-patient discussions, and may provide more impetus for men to choose active surveillance and avoid unnecessary treatment, the researchers added.

Each year, some 200,000 U.S. men are diagnosed with prostate cancer. While about 60 percent of those men don't actually need treatment (because their tumors are low risk and localized), more than 90 percent will still be treated, said Hayes, who is a genitourinary oncologist with the Dana-Farber Cancer Institute and an instructor in medicine at Harvard Medical School.

Active surveillance involves following men closely with prostate-specific antigen (PSA) tests, digital rectal examinations and regular biopsies. If the disease turns out to be more aggressive than initially thought, "they can be treated with curative intent," Hayes said. "The goal is to not treat those who don't need to be treated."

Studies to determine the effectiveness of active surveillance would take decades to complete and researchers simply don't have long-term data yet on how wise this strategy really is.

So, the computer model involved a hypothetical group of 65-year-old men with localized, low-risk prostate tumors.

The patients were treated first with brachytherapy (placing radioactive "seeds" in or near the tumor), IMRT, a radical prostatectomy (removal of the prostate gland) or they were followed using active surveillance.

Then the researchers used a measure called Quality-Adjusted Life Expectancy (QALE) to compare active surveillance to initial treatment. QALE measures both the quality and length of each patient's life.

Active surveillance (and IMRT later if needed) was associated with more QALE at 11.07 quality-adjusted life years (QALYs). Brachytherapy produced a 10.57 QALYs rating, followed by IMRT at 10.51 QALYs, and surgery to remove the prostate at 10.23 QALYs.

QALYs are a measure often used by scientists to indicate "the number of good quality years of life left," explained Dr. Stephen Freedland, associate professor of surgery at Duke University Medical Center, who was not involved with the study. Basically, it refers to how many "good" years are left.

And therein lie some of the complexities of translating these findings into the real world of real men.

"It depends on your definition of 'good,'" Freedland said. "The complications we are discussing are bowel problems, urinary problems and sexual problems. They [patients] are not being tied to a ventilator or being bed-bound. So, while important and significant, they are all in your interpretation of 'good.' Some men just don't care about erectile dysfunction. It's all about seeing their grandkids grow up. For others, sexual function is paramount and they would be willing to trade some quantity of life for quality of life."

"If someone has had a brother who has died of prostate cancer and is anxious about it, their [preference] is going to be lower, so [active surveillance is] probably not an appropriate approach," Hayes added.

So then the challenge is picking which patients are right for active surveillance.

"I wholeheartedly agree with the essential premise that for the right patient this is a reasonable choice. The challenge is, who is the right patient?" Freedland asked. "I feel very comfortable suggesting this for a man with low-risk cancer who is 65, but what happens when he's 55 or 45? The chances of him having a problem in the next 10 years are really low but he has 35 years to live," he said.

"The chance that his cancer will need to be treated in the next 35 years is probably reasonably high so why not treat it now?" Freedland added. "That's not my argument but that's the elephant in the room."

More information

The U.S. National Cancer Institute has more on prostate cancer.

SOURCES: Julia H. Hayes, M.D., genitourinary oncologist, Dana-Farber Cancer Institute, and instructor in medicine, Harvard Medical School, and senior scientist, Institute for Technology Assessment, Massachusetts General Hospital, Boston; Stephen Freedland, M.D., associate professor of surgery, Duke University Medical Center, Durham, N.C.; Dec. 1, 2010, Journal of the American Medical Association


'/>"/>
Copyright©2010 ScoutNews,LLC.
All rights reserved

Related medicine news :

1. Despite Treatment, Employees with Depression Generate Higher Absentee Costs, According to Thomson Reuters Study
2. American Council on Exercise (ACE) Study Reveals Kettlebells Provide Powerful Workout in Short Amount of Time
3. TV drama can be more persuasive than news program, study finds
4. Study carried out into biological risks of eating reptiles
5. Neuroimaging study may pave way for effective Alzheimers treatments
6. Study finds racial gaps continue in heart disease awareness
7. Luth Researchs IndicatorEDG(TM) Study Finds Americans Hopes of Achieving Their Dreams Are Fading
8. First blinded study of venous insufficiency prevalence in MS shows promising results
9. Soothing infants with food focus of childhood obesity study
10. People with anxiety disorder less able to regulate response to negative emotions, study shows
11. American Heart Association Rapid Access Journal Report: Study Finds Racial Gaps Continue in Heart Disease Awareness, Low Knowledge of Heart Attack Warning Signs Among Women
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:5/6/2016)... ... May 06, 2016 , ... Kenneth Cochran, DSc, RN, FACHE, ... of the South announced today that Dr. Robert Menuet, Interventional Cardiologist with Cardiovascular ... Ultrasound Guided Coronary Atherectomy. , This procedure involves the removal of ...
(Date:5/5/2016)... CA (PRWEB) , ... May 05, 2016 , ... TransWipe ... Final Cut Pro X. Drag and drop a TransWipe preset between two video clips ... from smooth corner wipes to colored panels with customizable color and orientation options. TransWipe ...
(Date:5/5/2016)... ... May 05, 2016 , ... ... (LAIs), today announced a development collaboration with the Australian critical medicine company, ... disorders such as schizophrenia. , LAI medicines can offer improved therapeutic benefits over ...
(Date:5/5/2016)... ... May 05, 2016 , ... Einstein Medical is proud to announce ... latest news and commentary at the 2016 ASCRS/ASOA Symposium and Congress, which takes place ... of Cataract and Refractive Surgery and the American Society of Ophthalmic Administrations will be ...
(Date:5/5/2016)... ... ... Friday, May 6 - Sunday, May 8, fifteen elite athletes from Team Semper Fi ... Bike Camp, hosted in conjunction with WTB and Cannondale in Novato, ... share pro tips with the injured veterans as they rip down some of the best ...
Breaking Medicine News(10 mins):
(Date:5/5/2016)... , May 5, 2016 ... of the  "Europe Systemic Lupus Erythematosus Market ... to their offering.       (Logo: ... latest research Europe Systemic Lupus Erythematosus Market ... comprehensive insights into Systemic Lupus Erythematosus pipeline ...
(Date:5/4/2016)... 2016  It,s time for an upgrade. There are many medical recorders on the ... LCD, the illustrious DVMAXX HD  offers unparalleled connectivity and functionality.  Ampronix  is a ... class manufacturer of innovative technology.  Photo - http://photos.prnewswire.com/prnh/20160503/363416 ... ... ...
(Date:5/4/2016)... Yissum Research Development Company of the ... had signed an exclusive world-wide licensing and research agreement ... degradation and immunomodulatory drugs for cancer and immune dysfunction, ... first-in-class therapy for hematologic and solid malignancies. Financial terms ... novel technology was developed by Yinon Ben-Neriah , ...
Breaking Medicine Technology: