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More men with prostate cancer are opting for surveillance

Men with early-stage prostate cancer are increasingly opting for regular monitoring and holding off on treatment unless the disease progresses, a new study suggests.
Use of so-called active surveillance, or watchful waiting, among men with localized prostate cancer was low from 1990 through 2009 but rose sharply between 2010 and 2013, according to data published in JAMA.
"This is progress in the right direction," said lead author Dr. Matthew Cooperberg of the University of California, San Francisco.
One in seven men will be diagnosed with prostate cancer during his lifetime, according to the American Cancer Society (ACS).
Many men whose tumors are confined to the prostate do not die of the cancer, according to the US Centers for Disease Control and Prevention. They also likely won't have symptoms.
There are several possible treatments for prostate cancer, including surgery and radiation. Some men – especially those who are older – may opt for active surveillance.
Men using active surveillance may undergo tests or biopsies to make sure the cancer isn't growing, the ACS says.
The approach helps avoid more aggressive treatments, which can carry the risk for complications such as incontinence and impotence.
For the new study, Cooperberg and his coauthor Dr. Peter Carroll used data from 10,472 men with localized prostate cancer treated at 45 US urology practices between 1990 and 2013.
Overall, the use of surveillance among men with low-risk cancer ranged from 7 to 14 percent from 1990 through 2009, but then increased to 40 percent between 2010 and 2013.
The ideal rate of active surveillance for low-grade disease isn't clear, Cooperberg told Reuters Health, but "it’s probably higher than 40 percent."
Among men age 75 or older, 76 percent opted for surveillance from 2010 through 2013, researchers found.
The researchers also found that use of a therapy called androgen deprivation for intermediate- and high-risk cancers fell by the end of the study.
Cooperberg said that's also a trend in the right direction, because androgen deprivation, which limits the effect of hormones on the cancer, should not be used alone.
"It has never been endorsed as single therapy for localized disease," he said. "We’re seeing a drop off of its (solo) use."
With more men choosing surveillance for their prostate cancer, the researchers hope it will reopen the discussion on screening to measure blood levels of prostate-specific antigen (PSA), which are often high in men with prostate cancer.
One argument against PSA screening is that men may go on to have aggressive treatment for cancer that might never have caused them problems. The researchers hope the decline in use of aggressive treatments – as inferred from the increase in surveillance – will lead to a re-evaluation of the risks of PSA testing.
"Our hope is that these findings and other papers with similar findings will really start to reopen the question on early detection and screening," Cooperberg said.
Currently, the government-backed US Preventive Services Task Force (USPSTF) recommends against screening for PSA levels.
The American Urological Association recommends against PSA screening in men younger than 40. It does not recommend routine screening between ages 40 and 54, or after age 70 for men with less than a 10 to 15 year life expectancy. It recommends that men ages 55 to 69 decide about PSA testing after discussions with their doctors.

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