Vigilant waiting in prostate cancer becomes more popular

In 2010, the US National Comprehensive Cancer Network's guidelines suggested that patients with stable, low-risk prostate cancer could be managed with active surveillance or supervised waiting (AS / WW). AS / WW was considered a safe and effective alternative to aggressive surgery to remove prostate and radiotherapy.

A new study examined trends in the management of prostate cancer between 2010 and 2015 and found that this trend of AS / WW had actually caught up with treating physicians. Results from the study of researchers from the Dana-Farber Cancer Institute of Brigham and Women's Hospital in Boston were published in the latest issue of the journal JAMA.

Image Credit: Image Point Fr / Shutterstock

A team of researchers, for this study, examined the management of localized prostate cancer in 164,760 men between 2010 and 2015. They obtained this data from the national database of cancer statistics – Surveillance, Epidemiology and final results. In 2010, the use of AS / WW was 14.5% and it rose to 42.1% in 2015, write the researchers. This mode of management has become more popular than they write. The use of this approach has also increased in men with intermediate-risk disease and has remained similar in men with high-risk prostate cancer.

• They noted that the number of radical prostatectomy operations decreased from 47.4% in 2010 to 31.3% in 2015. The use of radiation therapy had increased from 38% in 2010 to 26.6% in 2015 .
• Among intermediate-risk cancer cases, AS / WW rates increased from 5.8% to 9.6%. Similarly, among these cases, prostatectomy increased from 51.8% to 50.6% and radiotherapy from 42.4% to 39.8%.
• Active surveillance of high-risk patients was unchanged (1.9% to 2.2%), while prostatectomy increased from 38% to 42.8% and radiotherapy from 60.1% to 55% in 2010 and 2015 respectively.

The researchers explain that, compared to high-risk or intermediate-risk cancers, low-risk prostate cancer develops very slowly and can therefore be considered a therapeutic alternative to surgery and radiotherapy. They explain that surgery and radiation cause many side effects such as bleeding, nerve damage, urinary or feces leakage, infections, erectile dysfunction, etc.

Brandon Mahal, lead author and clinical researcher in radiation oncology at the Dana-Farber Cancer Institute, said in a statement: "We found that in low-risk prostate cancer, the use of active surveillance had almost tripled … Overall, these numbers are a good sign and a good thing. From 2010 to 2015, there has been a lot of new evidence – the highest level of evidence that can be obtained in medicine, which are prospective trials and some of them randomized trials – that have shown that active surveillance, conservative approaches or non-treatment approaches to low-risk prostate cancer have very favorable results. He called this study a "reference".

Prostate cancer is the second most common cancer among men in the world. According to the World Cancer Research Fund, 1.3 million new cases of prostate cancer have been diagnosed in 2018. According to the National Cancer Institute, 11.2% of men in the United States are at risk of contracting prostate cancer in Canada. a moment of their life.