Different Treatment Option for Low-Risk Prostate Cancers

Active surveillance increases in prevalence.

Reform in treatments for prostate cancer patients will hopefully lead to a higher rate of prostate-specific antigen (PSA) screenings, according to a recent study.

For decades, prostate cancer treatments have been mismatched. Men with low-risk tumors faced aggressive radiation treatment, while high-risk cancers went by undetected.

For low-risk tumors, aggressive treatments are not always necessary to prolong survival. Over the past few decades, physicians stopped recommending PSA screenings due to these overtreatment problems, but this leads to high-risk cancers going undetected.

The study conducted by Matthew Cooperberg, MD, MPH, and senior author Peter Carroll, MD, MPH aimed to shed light on better prostate cancer options based on the risk level. 10,500 prostate cancer patients were studied from over 45 different facilities, from low-risk, intermediate-risk and high-risk cancers.

Decades ago, radiation therapy was commonly used, even for low-risk patients. Today, another option is available: active surveillance, in which disease progression is closely monitored through blood tests and biopsies. Further treatment does not happen unless signs of progression are found.

From 1990-2009, 10% of men opted for this option. From 2010-2013, it was the treatment choice for 40% of low risk prostate cancer patients.

"Active surveillance has been a mainstay for years at UCSF and a few other academic centers, but is increasingly broadly endorsed in recent years,” Dr. Cooperberg said. “Our study follows on from numerous others that have documented consistent overtreatment of low-risk cancer that would never cause any symptoms or loss of life expectancy had it never been diagnosed. At the same time we're seeing more aggressive management of higher-risk disease, which will lead to better outcomes.”

Active surveillance offers a better option for low-risk patients, so that PSA screening can be conducted without fear of overtreatment. In the past, PSA screenings only led to unnecessary aggressive treatments, even if the cancer was mild enough to go untreated.

However, this lack of emphasis on screening can also make more aggressive strands of the cancer go undetected.

"Because of concerns about overtreatment, many primary care physicians no longer support PSA testing. This means that low-risk tumors, which do not require treatment, go unnoticed," said Carroll. "But it also means that high-risk tumors that are potentially lethal without early identification and intervention may go unnoticed, too. We hope the results of this study will lead toward a smarter screening and treatment paradigm, which is what many men need and deserve."

This study was published in JAMA, 2015.