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Opting not to treat in prostate cancer

A study of prostate cancer patients suggests that active surveillance may be the best option for some men diagnosed with low-risk disease

A multicentre study of prostate cancer patients in the US and Canada suggests that active surveillance may be the best option for some men diagnosed with low-risk disease. The research, published in the Journal of Urology, is prompted by the fact that up to half of all men diagnosed with prostate cancer die from another cause. 

Active surveillance builds on the concept of watchful waiting – which aims to avoid treatment unless symptoms develop. It includes more monitoring by specialists and aims to find and treat those cancers more likely to grow and cause symptoms. Prostate cancer can be treated with radiation therapy and surgery but this may result in serious long-term side effects, such as incontinence and erectile dysfunction.

Dr Scott Eggener, one of the authors of the paper and assistant professor of surgery at the University of Chicago Medical Center, says: "When or if to treat men with low-risk prostate cancer has always been a challenging question that faces patients and urologists." 

The researchers recorded disease progression in 262 men and report that a second biopsy is important to ensure that those patients who have developed a higher number of cancerous cores can be treated. In total, 219 of the men studied remained on watchful waiting without evidence of cancer progression. Of the 43 who received treatment, all but one were cured of the disease.

"Active surveillance with delayed treatment, if necessary, for select patients appears to be safe and associated with a low risk of metastatic spread," the authors conclude.

17th March 2009

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