Conservative management of low-risk prostate cancer increasing in USA
medwireNews: US patients with low-risk localized prostate cancer are increasingly being managed with active surveillance or watchful waiting, finds a database analysis.
The proportion of men managed by these conservative approaches rose from 14.5% in 2010 to 42.1% in 2015, a significant difference. The use of radical prostatectomy and radiotherapy in these men concurrently decreased significantly from 47.4% to 31.3% and from 38.0% to 26.6%, respectively.
The findings were similar for patients classed as intermediate risk, but the changes were smaller albeit still statistically significant, with active surveillance/watchful waiting rates rising from 5.8% to 9.6% and radical prostatectomy and radiotherapy rates declining from a respective 51.8% to 50.6% and 42.4% to 39.8%.
Among men with high-risk disease, the use of active surveillance/watchful waiting was comparable in 2010 and 2015, at 1.9% and 2.2%, respectively, while the rate of radical prostatectomy increased significantly from 38.0% to 42.8% and the rate of radiotherapy decreased significantly from 60.1% to 55.0%.
“Although increasing use of [active surveillance/watchful waiting] for low-risk disease has been supported by high-level evidence and guidelines since 2010, shifting management patterns toward more radical prostatectomy in higher-risk disease and away from radiotherapy does not coincide with any new level 1 evidence or guideline changes,” write Brandon Mahal (Dana-Farber Cancer Institute, Boston, Massachusetts, USA) and co-authors in a research letter to JAMA.
And they conclude: “The potential downstream effects of efforts to increase [active surveillance/watchful waiting] for men with low-risk disease on management of other risk groups requires further examination.”
The study included data from the custom Surveillance, Epidemiology, and End Results Prostate Active Surveillance/Watchful Waiting database on 164,760 men with available information regarding the management strategy of localized prostate cancer diagnosed between 2010 and 2015.
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