Some men may avoid prostate cancer screening, delaying aggressive treatment


LONDON — More men with prostate cancer are able to delay their treatment, a decades-long study has found, with active surveillance by healthcare professionals an equally valid — and less drastic — option.

The study, published Saturday in the New England Journal of Medicine, followed more than 1,600 men newly diagnosed with localized prostate cancer in the United Kingdom. The study found that up to 21 years after diagnosis, patients were less likely to die from the disease if they were actively monitored or treated with radiation or surgery.

More aggressive treatment helped slow the progression of the disease, but did not reduce the overall risk of men dying from the disease. The authors say this finding suggests that “more aggressive treatment may do more harm than good” — because the side effects of those treatments can leave patients debilitated, and ultimately ineffective.

This is “very good news for patients,” said Freddie Hamdy, professor of surgery and urology at the University of Oxford and lead author of the study. Until more men carefully monitor changes in their condition, aggressive treatments that can cause lasting side effects can be delayed.

That kind of monitoring is already offered to low-risk prostate cancer patients in the United Kingdom and the United States, but the study “could be safely extended to intermediate-risk disease,” Hamdi said. This can give some hope to people suffering from prostate cancer Fourth – the most common Cancer type worldwide.

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As part of a study funded by the British government, more than 80,000 men aged 50 to 69 were screened for prostate cancer between 1999 and 2009. More than 2,600 people were diagnosed with the disease, and 1,643 were included in the trial.

The men were at low or intermediate risk from their disease, and the authors emphasized that their findings may not apply to men at high risk. “High-risk patients need rapid and intensive treatments,” Hamdi said.

The researchers divided the men in the group into three groups, who were either monitored over time or treated with radiotherapy or prostatectomy, a surgical procedure to remove all or part of a patient’s prostate. The goal was to measure and compare the effectiveness of each treatment.

After 15 years post-diagnosis, the men were given a follow-up to see how they were doing. Less than 3 percent died of prostate cancer, and the odds were similar for each treatment group. For example, 3.1 percent of deaths occurred among men in the active-surveillance group, compared with 2.9 percent among men who received radiation therapy.

Without treatment, men in the active-surveillance group were twice as likely as men in the aggressive treatment groups to see their prostate cancer progress and spread — or form what are known as metastases. But that improvement didn’t lead to a greater chance of death. This surprised the researchers, and according to Hamdi, “If men develop metastases, that doesn’t mean they’re going to die of prostate cancer” — they could be dying of other causes.

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Because prostate cancers typically progress slowly, the study’s finding suggests that even if the cancer develops quickly under intensive surveillance, the long-term harmful effects of intensive treatment may not be worth it.

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Active monitoringAlso known as Active monitoring, already used in many low-risk men. It “does nothing,” Hamdi said. Patients on active surveillance are regularly examined by a physician for “any indication that the disease is progressing.” If the cancer progresses, the patient may need surgery, radiation, or hormone therapy. In the study, most of the men in the active-surveillance group eventually received some form of intensive treatment.

Jenny Donovan, professor of social medicine at the University of Bristol and co-author of the study, said some men decide to seek intensive treatment because they don’t fully understand that they may be delaying that treatment. Survival – and some later “regret their decisions.”

Separately Paper, published Saturday in the same medical journal, researchers revealed that many men who undergo invasive treatment report negative side effects lasting up to 12 years. These side effects include urinary leakage and erectile dysfunction. They “come on very soon after treatment, but last for a long time,” Donovan said, arguing that it’s important for patients to weigh these effects against the potential benefits of treatment.

“Now, men diagnosed with localized prostate cancer can use their own values ​​and priorities to make difficult decisions about which treatment to choose,” Donovan said in a news release.

Overall, Hamdi said, patients “shouldn’t panic when they’re diagnosed with prostate cancer.” “But if they’re at high risk, they really need to get counseling and get better treatment.”

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