Men who choose active surveillance for early prostate cancer often do not follow surveillance rules

Preliminary findings from a study conducted by the University of North Carolina's Lineberger Comprehensive Cancer Center revealed that only 15% of a North Carolina men's group suffered from cancer. Early stage prostate cancer who opted for active surveillance instead of treatment followed the recommended surveillance guidelines.

The findings, presented Sunday, June 2 at the American Society of Clinical Oncology Annual Meeting 2019 in Chicago, were derived from an badysis of 346 men recently diagnosed between 2011 and 2013 with cancer-related cancer. low-risk or intermediate-risk prostate cancer in North Carolina. The researchers badyzed the frequency with which men received biopsies and other tests in accordance with National Comprehensive Cancer Network guidelines.

"Active surveillance is subject to stringent guidelines: people need regular PSA tests, they need a prostate exam, prostate biopsies so you can monitor the cancer very closely, and you do not lose the opportunity to treat cancer when it starts to grow, "Ronald C. Chen, UNC doctor at UNC Lineberger, an badociate professor at Department of Radiation Oncology of the UNC School of Medicine. "One of the main conclusions of this study is that, in this population-based cohort, and not in a clinical trial or in a purely academic setting, only 15% of patients undergoing active surveillance benefited from any of these studies." recommended monitoring. "

The data showed that active surveillance was safe, but researchers at UNC Lineberger noted that these data had been extracted from clinical trials or studies conducted in large academic institutions. To evaluate surveillance in a large population, they studied a group of North Carolina patients to determine whether they adhered to the NCCN's active surveillance guidelines, which recommended screening tests for prostate antigen. (PSA) at least every six months, digital rectal examinations every year, and a repeat biopsy within 18 months of diagnosis.

In the first six months, 67% of patients had a PSA test and 70% had a digital rectal exam. Only 35% had a biopsy in the first 18 months. Of all types of tests performed after 24 months, only 15% of patients received follow-up surveillance.

"Based on the NCCN guidelines, and which we believe most community practices would follow in terms of active surveillance guidelines, we find that very few patients who chose to undergo active surveillance actually benefited from the recommended monitoring" said the manager. Sabrina Peterson, first author of the study, student at the UNC School of Medicine.

The researchers also reported that they found no variables, such as income, race or age, related to adherence to monitoring guidelines by patients. The results led researchers to request more research on the results of active surveillance outside of controlled studies.

"This raises the question of whether there is a need to research whether active surveillance is a safe option when patients do not benefit from routine surveillance," Chen said. "Our goal is not to reduce the number of patients who choose active surveillance, but the results of this study should instead increase awareness and efforts to ensure that patients under active surveillance are included in the study." Rigorous supervision. "

Researchers also badyzed trends in patients who stopped active surveillance and started treatment. In addition to the fact that the progression of the disease prompted patients to switch to treatment, they also established that the patient's level of anxiety was related to whether or not she stopped active surveillance and switched to treatment.

"When we looked at some of the reasons why people would be treated rather than under active surveillance, anxiety seems to be one of the reasons people are treated and end active surveillance," he said. Chen said.

In addition to Chen, Sabrina Peterson, Ramsankar Basak, Dominic Himchan Moon, Claire Liang, Deborah S. Usinger, Sarah Walden and Aaron J. Katz were among the authors.

The study was funded by the Institute for Patient-Centered Outcome Research and the Agency for Health Research and Quality.