Prostate Cancer: Active Surveillance Offers Quality-of-Life Gains
'Watchful Waiting' May Offer More Benefits Than Treating the Disease in Select Cases
Treatments vs. Active Surveillance continued...
Brachytherapy and IMRT were less effective, and radical prostatectomy was the least effective treatment in terms of this measure. Active surveillance provided six additional months of QALE compared with brachytherapy, which was the most effective initial treatment, the study showed.
“The findings suggest that for men affected by these smaller, lower-grade tumors, active surveillance is a reasonable approach as an initial treatment option, although individual patient preferences must be carefully considered,” write Ian M. Thompson, MD, of the University of Texas Health Science Center in San Antonio and Laurence Klotz, MD, of the Sunnybrook Health Science Center in Toronto, Canada, in an accompanying editorial.
For some men, the quality-of-life gains will not be as pronounced because they will be overcome with anxiety about the cancer, they write.
Accepting Active Surveillance
“Active surveillance is reasonable in a proportion of patients, but this paper should not be misconstrued to think that most patients should have active surveillance at age 65,” says Reza Ghavamian, MD, director of the prostate cancer program at the Montefiore-Einstein Center for Cancer Care and director of urologic oncology and robotic urology at Montefiore Medical Center in New York. “That’s not true.”
Treatment has to be individualized, he says.
“Some patients may say ‘it affects my quality of life, if I know I have a cancer that I am just watchfully waiting,' and some people say ‘I don’t care as long as doctor is watching it for me,'” he says.
“There should be a wider acceptance of the concept of active surveillance,” says Jeri Kim, MD, an associate professor in the department of genitourinary medical oncology at the University of Texas M.D. Anderson Cancer Center in Houston. But “a lot of people are afraid of having cancer and not doing anything about it, and this study is one of the first to come out that really tells us that it's a reasonable option for men with low-risk prostate cancer.”