Men with slow-growing, low-risk prostate cancer may not live long enough to die from their disease. And because there isn’t a conclusive evidence that treating low-risk prostate cancer increases survival, doctors may recommend monitoring the cancer and treating it only when it has began to spread.
This is known as lively monitoring. It is generally reserved for men with small, slow-growing tumors and a standard life expectancy of lower than 10 to fifteen years after diagnosis. Older men specifically are way more prone to die from heart disease and other causes than from low-risk prostate cancer. This has fueled growing concerns that low-risk cases are being overtreated, with many men suffering uncomfortable side effects without advantages.
Doctors monitor men's lively surveillance in 3 ways:
- Periodically measuring the quantity of prostate-specific antigen within the blood
- Checking for tumor growth with digital rectal exams
- Repeat biopsies at different intervals.
Active monitoring begins.
Although it has a protracted history, lively surveillance has recently broadened its reach from academic cancer centers to the broader community. Now a brand new study shows that its adoption is accelerating.. “The trend is real and it's a step in the right direction,” said Matthew Koperberg, MD, associate professor of urology, biostatistics and epidemiology on the University of California, San Francisco Medical Center.
Koperberg and co-author Peter Carroll, chair of the UCSF urology department, reviewed data from greater than 10,000 men with low-risk prostate cancer treated at 45 urology practices across the United States. From 1990 to 2009, the speed of lively surveillance use amongst men who were a median of 66 years old when diagnosed was slightly below 15 percent. But between 2010 and 2013, rates suddenly rose to greater than 40 percent. An analogous trend was seen in men aged 75 years or older at diagnosis – the speed of lively surveillance increased from 54% to 76% throughout the same period.
“Overtreatment of low-risk prostate cancer is a significant problem, and these results suggest that it is decreasing,” Koperberg said.
With studies from Sweden, Australia, Michigan, and elsewhere showing similar increases, proactive monitoring “appears to be gaining traction as a standard management practice,” said Stacey Loeb, in New York City. Urologist and researcher at New York University School of Medicine.
The way forward for prostate cancer surveillance
Long-term data confirm the security of lively surveillance for low-risk disease. For example, a Canadian study published this 12 months found that just one.5 percent of 993 men enrolled in an lively surveillance protocol in 1995 had died of prostate cancer twenty years later. The men were on average 69 years old on the time of diagnosis. “But active surveillance isn't just for older men,” Koperberg stressed. “Our data suggest that it may also be effective in younger men.”
Scientists are also in search of less invasive ways to observe tumor growth – for instance, with imaging tests or more precise markers in blood and urine. These alternative methods could make lively monitoring much less time-consuming.