April 19, 2024 – Men with low-risk prostate cancer who undergo energetic surveillance moderately than treatment should ideally be followed for 15 years – and possibly indefinitely – based on one among the biggest studies thus far on the topic.
Previous studies have shown that energetic surveillance for 15 years is adequate to discover men whose disease progresses and who require treatment. But now 25 years of information suggest that “careful follow-up over a longer period is required if the chance for a cure is not to be missed,” said Dr. Emmeli Palmstedt, a research student within the Department of Urology on the Sahlgrenska Academy on the University of Gothenburg, Sweden. “These data are crucial given the high life expectancy” of men in otherwise good health.
Palmstedt presented the outcomes on the 2024 Annual Meeting of the European Association of Urology.
In many cancer clinics, energetic surveillance is a normal of look after men with low-risk prostate cancer, based on a benefit-risk ratio that favors delayed intervention, Palmstedt said. Several studies have supported follow-up for 15 years, but recent data now support this assumption
Treatment-free survival drops to 31%
The rate of patients surviving without treatment, estimated at 65% in a 15-year evaluation published in 2016, has dropped to 31%. The rate of unsuccessful survival – meaning a patient lives with the disease during and after treatment but their condition doesn't worsen – was 59%, the researchers said, and prostate cancer-specific survival was 92%.
Palmstedt found that deaths from prostate cancer amongst all low-risk patients have increased fourfold for the reason that 2016 figures were released (8% versus 2%). The proportion of men who aren't any longer living without reoccurrence has increased from 10% to over 40%.
“These are not negligible numbers,” said Palmstedt, adding that the general survival rate had fallen from 69% after 15 years to 37% after 25 years.
Although some men between the ages of 15 and 25 have been advised to adopt a watchful waiting approach—that's, doctors monitor the prostate cancer until it has metastasized or caused symptoms—these data haven't yet been evaluated.
The low death rate from prostate cancer over the long run is reassuring, said Palmstedt, but an important message of the brand new study is that energetic surveillance allows for curative treatment even after longer follow-up. She stressed that patients whose disease doesn't progress after 15 years can't be considered “safe.”
Based on these data, “men with a high remaining life expectancy should be informed that active surveillance is still useful even after 15 years,” says Palmstedt.
Active monitoring now more frequent
Over the past decade, the proportion of men with prostate cancer treated with energetic surveillance has steadily increased, based on Matthew R. Cooperberg, MD, MPH, professor of urology on the University of California, San Francisco. In a study published last yr in JAMA network openedCooperberg and his colleagues reported that The rate of energetic surveillance has increased from 26.5% in 2014 to 59.6% in 2021. However, given the importance of this approach to avoiding overtreatment of men with low-risk prostate cancer, even this increase is just not enough, he said.
“The window of opportunity for a cure is usually very large,” Cooperberg said. Although many men “will never need treatment, long-term monitoring for those who do need it is definitely important,” he said. Data from trials support the principle that this strategy still keeps open the potential of treatment whether it is needed.
“Curative treatment at age 70 is generally far preferable to treatment at age 55, and for the vast majority of men who have only mild disease at diagnosis, surveillance should absolutely be the preferred treatment,” he explained.