The Best Treatment for Low-Risk Prostate Cancer? Depends on the Patient.

Men diagnosed with low-risk prostate cancer can opt for active surveillance rather than more invasive treatments without worrying about losing quality of life, suggests a study published in the Journal of the American Medical Association.

Researchers ran a computer simulation using data (culled from previous studies) on the success of various treatments. It found that in 65-year-old men, closely monitoring the patient to see if the disease progresses produced 11.1 quality years of life, compared to about 10.6 for internal radiation and 10.5 for external radiation. Men who have a radical prostatectomy can expect about 10.2 quality years of life, the model showed.

Of course, the results will depend on the assumptions used in the model. Randomized trials are the best way to compare different interventions (or non-interventions), but many men are uncomfortable being randomized to no treatment, says Ian Thompson, chairman of the urology department at the University of Texas Health Science Center at San Antonio. Thompson was the co-author of an editorial accompanying the research.

“The point is not necessarily that active surveillance was superior, but that with a wide range of assumptions, it wasn’t inferior,” he tells the Health Blog. “A man who faces a diagnosis of one of these smaller, slower-growing tumors should be offered this.” And decisions will vary depending on individual preferences — a man who really doesn’t want to experience the side effects of treatment such as impotence and incontinence will make one decision, while a man who dislikes uncertainty may make another, he says.

We wrote recently about a study that found men with low-risk prostate cancer often receive aggressive treatment. According to this latest study, last year more than 190,000 men in the U.S. were diagnosed with prostate cancer, with 70% classified as having localized, low-risk disease. But while 90% of men with cancer will be treated, up to 60% may not require treatment. The trick is figuring out which of them can opt out. Right now we can’t predict that with 100% confidence, says Thompson, though he says he’s confident that better tests to do just that are on their way.

When a man and his family receive this diagnosis, “the physician really needs to step up and inform them what it really means,” Thompson says. “It’s not a no-risk circumstance, but it’s a low-risk one. Cancer is not cancer is not cancer.”

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