Prostate cancer does not require treatment for years: study

Researchers found long-term evidence that active surveillance for localized prostate cancer is a safe alternative to immediate surgery or radiation.

The results, released on Saturday, are encouraging for men who want to avoid sexual problems and incontinence related to the treatment, said Dr. Stacy Loeb, a prostate cancer specialist at NYU Langone Health who was not involved in the research.

The study directly compared three methods – surgery to remove tumors, radiation treatment and monitoring. Most prostate cancer grows slowly, so it takes years to see the results of the disease.

“There was no difference in prostate cancer mortality at 15 years between the groups,” Loeb said. And prostate cancer survival for all three groups is high – 97% regardless of treatment method. “That’s good news too.”

The results were published on Saturday in the New England Journal of Medicine and presented at a European Association of Urology conference in Milan, Italy. The National Institute for Health and Care Research in Britain paid for the research.

Men diagnosed with localized prostate cancer should not panic or rush into treatment decisions, said lead author Dr. Freddie Hamdy of the University of Oxford. Instead, they should “carefully consider the possible benefits and side effects of treatment options.”

A small number of men with high-risk or more advanced disease need urgent treatment, he added.

Researchers followed more than 1,600 men in the UK who agreed to be randomly assigned to get surgery, radiation or active monitoring. The patients’ cancer was confined to the prostate, a walnut-sized gland that is part of the reproductive system. The men in the monitoring group had regular blood tests and some continued with surgery or radiation.

Death from prostate cancer occurred in 3.1% of the active monitoring group, 2.2% of the surgery group, and 2.9% of the radiation group, differences that were considered statistically insignificant.

At 15 years, the cancer spread to 9.4% in the active monitoring group, 4.7% in the surgery group and 5% in the radiation group. The study began in 1999, and experts say monitoring methods are better now, with MRI imaging and gene tests guiding decisions.

“We have many ways now to help catch the disease in progress before it spreads,” Loeb said. In the US, about 60% of low-risk patients choose monitoring, now called active surveillance.

Hamdy said the researchers saw a difference in cancer spread at 10 years and expected it to make a difference in survival at 15 years, “but it didn’t.” He said that prevalence alone does not predict prostate cancer death.

“This is a new and interesting finding, useful for men when they make decisions about treatments,” he said.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. AP is solely responsible for all content.

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