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Prostate Cancer: No Treatment OK for Some

Outcomes Good With Active Surveillance, New Study Suggests

Prostate Cancer Without Treatment continued...

All the men were younger than 75 at recruitment, with the average age being 64. All had early-stage, localized disease and all had the most favorable biological disease markers, including a prostate-specific antigen (PSA) score of below 10 ng/mL and a Gleason score of 6 or below.

Instead of having one biopsy to determine eligibility for active surveillance, the patients had two. The second biopsy was done between 3.7-10.5 months after the first biopsy. As a result of the second biopsy, about 30% of the patients who were initially considered candidates for surveillance were excluded from the study because they ended up undergoing treatment.

“We feel that the second biopsy was an important step in identifying patients who are not good candidates for active surveillance,” Eggener says.

Most Patients Did Not Progress

With active surveillance, the patients had physical exams and PSA tests every six months, with biopsies recommended every one to two years.

Over an average of two and a half years of follow-up, 43 of the study participants showed evidence of cancer progression and received treatment.

In two patients, cancer spread beyond their prostate.

The study is published in the April issue of the Journal of Urology.

The findings support the idea that some men with prostate cancer may not need treatment, American Cancer Society Deputy Chief Medical Officer Len Lichtenfeld, MD, tells WebMD.

He says the addition of a second biopsy should help refine the search for men who are appropriate candidates for active surveillance, but he also agrees that the strategy of watchful waiting is not without its risks.

“The real advance will be when we have tests that will tell us with a high degree of accuracy when treatment is needed and when it is not,” he says.

A great deal of research is being done to identify genetic tests or tumor markers that can do this, but Lichtenfeld says it will be years before these tests are validated.

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