Every cancer diagnosis comes with a range of reactions, including the natural inclination to act as quickly as possible to choose and begin treatment.
The Clinical Trial
The new findings are based on 15-year outcomes of the Prostate Testing for Cancer and Treatment (ProtecT) clinical trial sponsored by the University of Oxford. This long-term trial was initiated in 2001 and will continue until 2027.- The ProtecT trial included 82,429 men in the United Kingdom between 50 and 69 years of age who received a prostate-specific antigen (PSA) test from 1999 to 2009.
- Localized prostate cancer was diagnosed in 2,664 of the men.
- Researchers followed a subgroup of 1,643 men to assess the efficacy of three approaches: active monitoring, prostatectomy, and radiotherapy.
There are several possible explanations for this finding. The median PSA was relatively low among randomized patients; most of the trial patients were at low risk or favorable intermediate risk and would today be considered appropriate candidates for active surveillance.
Another possibility is that, in most cases, prostate cancer is a slow-growing cancer and may not necessarily lead to death if left untreated for some time.
Notably, patients who received radical prostatectomy or external-beam radiotherapy were more likely to experience adverse effects, such as urinary incontinence and erectile dysfunction, than those on active monitoring.
Based on these findings, the researchers concluded that active monitoring could be appropriate for some men with localized prostate cancer, particularly those with low-risk disease. This approach involves regular monitoring of the cancer with PSA tests and other diagnostic measures, with treatment initiated only if the cancer shows signs of progression.
Overall, the current study findings highlight the importance of balancing the potential benefits and harms of prostate cancer treatments.
Prostate Cancer Survival Rate Is High, But so Is the Number of Cases
In the United States, 1 in 8 men will be diagnosed with prostate cancer during their lifetimes. Older males and non-Hispanic black men have the highest risk of developing prostate cancer.Trends in Diagnosis
In an editorial published by the New England Journal of Medicine, Dr. Oliver Sartor, medical director of the Tulane Cancer Center, writes that current treatment approaches are very different today from when the ProtecT clinical trial started.The ProtecT trial relied on PSA testing, which, though still a standard test, is “no longer the norm,” writes Sartor.
Active Monitoring
Sartor writes, “Active monitoring as performed in the ProtecT trial should not be used today. We can do better by adding serial multiparametric MRI assessments.”Active monitoring, also known as active surveillance, is a management approach for prostate cancer. Patients with low- or intermediate-risk disease are closely monitored with regular PSA testing, prostate exams, and sometimes repeat biopsies but don’t receive immediate active treatment such as surgery or radiation.
It aims to avoid overtreatment and its potential side effects in patients who may never develop symptoms or die from cancer while providing timely treatment if cancer shows signs of progression.
Methods used for active surveillance have evolved over the past two decades, with new evidence and guidelines informing the approach. For example, MRI and targeted biopsy have become more common in recent years, allowing for more accurate tumor size and location assessment and reducing the need for repeat biopsies. Additionally, some risk-stratification systems have been developed specifically for active surveillance patients, considering factors such as age, PSA level, and biopsy results to identify patients who may be good candidates for this approach.
Active surveillance is not appropriate for all prostate cancer patients and should be considered on a case-by-case basis.
Patients with higher-risk diseases or who are uncomfortable with close monitoring without active treatment may opt for more aggressive treatment options such as surgery or radiation.
Men with localized prostate cancer shouldn’t rush their treatment choices or react with fear, according to lead ProtecT author Dr. Freddie Hamdy of the University of Oxford. Instead, they should “consider the possible benefits and harms caused by the treatment options.”
This may apply to other cancers as well.
4 Consequences of Overtreatment
Overtreatment can include aggressive treatments, such as surgeries and chemotherapy, that may not provide significant benefits and may even be harmful to patients.- Harmful side effects: Many medical treatments come with potential side effects or risks, and overtreatment can increase the likelihood of these adverse outcomes. For example, unnecessary surgeries can lead to complications, such as infections and organ damage.
- Reduced quality of care: Overtreatment can distract health care providers from focusing on essential aspects of patient care, such as preventive measures and chronic disease management.
- Financial burden: Overtreatment and rising health care costs can result in significant financial obligations for individuals, families, and society. This can be particularly challenging for uninsured and underinsured patients.
- Emotional burden: Overtreatment can be stressful for the patient and his family.
- Waste of resources: Overtreatment can lead to the overuse of medical resources, including unnecessary tests, procedures, and medications.
The ProtecT trial findings shouldn’t be interpreted as a recommendation to forgo treatment for localized prostate cancer. Each patient’s situation is unique, and the decision to undergo treatment or active surveillance should be made in consultation with a health care provider.