More men with low-risk prostate cancer choosing to delay treatment
An increasing number of UK men diagnosed with low-risk prostate cancer are choosing to have their condition monitored rather than immediately opting for aggressive treatment, it has been revealed.
In the first study of its kind, which was funded by the Institute of Cancer Research (ICR), Cancer Research UK and the NCRI South of England Prostate Cancer Collaborative, Dr Chris Parker set out to assess the impact of Active Surveillance on treatment choices among men with low-risk prostate cancer.
The technique helps to ensure that men with low-risk disease that has not spread beyond the prostate are given the option of regular monitoring instead of immediate treatment. The method allows some men to avoid surgery and radiotherapy - potential side-effects of which include impotence in half of cases and incontinence in one in 20.
Developed by Dr Parker, a clinical oncologist at the ICR and senior lecturer and honorary consultant at the Royal Marsden, Active Surveillance involves the regular monitoring of cancer progression by biopsy and checking the levels of prostate specific antigen in the blood.
It has been recommended as a treatment option for men with low-risk, localised prostate cancer by the National Institute for Health and Clinical Excellence (NICE) since 2008.
After looking at 43,322 localised prostate cancer cases recorded between 2002 and 2006 on the British Association of Urological Surgeons Cancer Registry, Dr Parker determined that 20 per cent of men met the criteria for low risk disease.
Over the period, the proportion of these men who opted for Active Surveillance rose steadily, with a corresponding decline in the proportion of patients choosing to undergo surgery and radiotherapy.
From a zero per cent starting point in 2002, 39 per cent of low-risk subjects decided to have Active Surveillance in 2006.
However, it is not clear whether Active Surveillance was offered as an option in all cases, and Dr Parker believes the technique will have proved more popular after NICE guidance was issued in 2008.
"This is the first study to examine the treatment choices of men diagnosed with low-risk prostate cancer in the UK, and it demonstrates a major increase over time in the use of Active Surveillance," Dr Parker confirmed.
"This growth in Active Surveillance use represents a significant shift of clinical practice in Britain and contrasts sharply with the US, where about 95 per cent of low-risk patients have radical treatment."
Older men were more likely to choose Active Surveillance over surgery and radiotherapy, the research demonstrated, as were men in the most deprived areas.
Dr Lesley Walker, director of cancer information at Cancer Research UK, said: "This study shows how Active Surveillance is changing the way doctors treat early prostate cancers. Prostate cancer is very common and in many cases it doesn't cause any problems during a man's lifetime.
"But it can be difficult for doctors to determine which prostate cancers need treatment and which cases don't. This system gives more options for men with low risk disease, helping many men to avoid unnecessary treatment altogether."
- McVey, G., McPhail, S., Fowler, S., McIntosh, G., Gillatt, D., & Parker, C. (2010). Initial management of low-risk localized prostate cancer in the UK: analysis of the British Association of Urological Surgeons Cancer Registry BJU International, 106 (8), 1161-1164 DOI: 10.1111/j.1464-410X.2010.09288.x