Prostate cancer progresses slowly, but how long is it possible to delay treatment? Most newly diagnosed men have low-risk or favorable forms of intermediate-risk prostate cancer that doctors can only see and treat if the disease is at high risk of progression. This approach, called lively surveillance, allows men to delay the necessity for aggressive treatment — or, in some cases, stay alive, which has difficult unwanted side effects.
In 1999, British researchers began a clinical trial comparing outcomes between 1,643 men who either had their cancer treated immediately or underwent lively surveillance (then called lively surveillance). ). The men had a median age of 62 at enrollment, and all had low- to intermediate-risk tumors with prostate-specific antigen (PSA) levels of three.0 to 18.9 nanograms per milliliter.
The results that got here out
During the study, called the Prostate Testing for Cancer and Treatment (PROTECT) trial, researchers randomized 545 men to lively surveillance, 533 men to surgical removal of the prostate, and 545 men to radiation. .
After a median follow-up of 15 years, 356 men had died of any cause, including 45 men who died exclusively of prostate cancer: 17 from the lively monitoring group, 12 from the surgery group, and 16 from radiation. From the group. Men within the lively surveillance group what The rate of cancer progression is higher in treated men than in untreated men. Most of them were eventually treated with drugs that suppress testosterone, a hormone that fuels prostate cancer growth.
Overall, 51 men within the lively surveillance group developed metastatic prostate cancer, nearly twice the variety of those treated with surgery or radiation. But 133 men within the lively surveillance group also avoided any treatment and were alive when follow-up ended.
Experts weigh in.
In a press release, the study's lead writer, Dr. Freddy Hamdi of the University of Oxford, claimed that although cancer growth and the necessity for hormonal therapy were more limited within the treatment groups, “that reduction did not translate into a difference in mortality.” Dr. Hamdi says the findings suggest that for some men, aggressive therapy ends in “more harm than good.”
Dr. Zeitman agrees, adding that today's lively surveillance protocols are even safer than those used when ProtecT was launched. Unlike previously, for instance, lively surveillance protocols now make greater use of magnetic resonance imaging (MRI) scans to detect prostate cancer progression.
“It's important not to stretch the data beyond what they mean,” says Dr. Gershman, who was not involved within the research. “These findings should not be used to infer that not all prostate cancers should be treated, or that there is no benefit to treatment for men with more aggressive disease.” Still, there may be a landmark study in Protect Urology, says Dr. Gershman, that “reinforces lively surveillance as the popular management strategy for men with low-risk prostate cancer and a few men with intermediate-risk prostate cancer. “