Thousands of men with prostate cancer are choosing to have their disease monitored rather than have radical treatments such as surgery or radiotherapy, according to a new report.
The approach is called active surveillance — which is a way of monitoring prostate cancer that isn’t causing any symptoms or problems. Active surveillance is often recommended if the cancer detected is small, low-risk and unlikely to cause problems.
The findings, published in the 2018 annual report of the Movember Prostate Cancer Outcomes Registry – Australia and New Zealand (PCOR-ANZ), found that more than two thirds (69 per cent) of men diagnosed with low-risk prostate cancer during 2015 to 2016 went on active surveillance.
Typically, active surveillance involves prostate-specific antigen (PSA) tests every three to six months, digital rectal examination every six months, mpMRI scans, and biopsies at 12 months and three years. If the cancer shows sign of faster or more aggressive growth, a patient can start treatment or undergo surgery.
However, the study found that the remaining 31 per cent of men with low-risk prostate cancer went on to have treatments they may not have needed. Treatments such as surgery and radiotherapy can carry life-changing side effects such as incontinence, problems with bowel functions and erectile dysfunction.
The study added to the ongoing dialogue around over-detection and over-treatment of prostate cancer, with some experts arguing it can be harmful.
“Men with low-risk prostate cancer could be spared long-term life changing side effects by choosing active surveillance rather than surgery or radiotherapy,” Professor Sue Evans, academic lead of the PCOR-ANZ registry, said in a statement. “The trend for choosing active surveillance is certainly a good thing and the registry can claim some credit for this. However, we want to see that trend increase further with the numbers of men opting for active surveillance above 90 per cent.”
Meanwhile, Dr Peter Heathcote, president of the Urological Society of Australia and New Zealand (USANZ) added: “To improve the take up of active surveillance by men we need improved education and support in a shared decision-making framework.”
Prostate cancer is the second most common cancer in men worldwide. More than 3,100 Australian men die from prostate cancer each year, with one in five males risk developing prostate cancer by age 85.
The study comes after Professor Richard Martin, from the UK, told Starts at 60 that screenings with a one-off PSA test weren’t enough to save lives. His comments followed research published in the JAMA Journal that found while PSA tests are an effective way of detecting cancers, they don’t actually reduce the number of prostate cancer deaths in the United Kingdom. That study analysed the effects of PSA testing on 400,000 men aged 50-69 and found that after 10 years, the PSA test detected more instances of cancer, but had little effect on mortality rate.
“A single, low-intensity PSA screen test still detects too many low-risk prostate cancers, while also missing cancers that do not need treatment,” Martin explained. “After an average 10-years of follow-up, the group who had been screened had the same percentage of men dying from prostate cancer as those who had not been screened. Men need to be told this, and new methods of testing need to be adopted and evaluated.
He suggested that many PSA tests weren’t always accurate in detecting cancer that has the potential to become deadly.
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