Comparing the value of surgery, radiation, monitoring for early prostate cancer

Men with early prostate cancer can safely opt out of treatment without increasing their risk, though more patients will want treatment later on even when it’s unnecessary.

The study published in the New England Journal of Medicine followed patients for 10years and found no difference in death rates among those who underwent surgery, those who opted for radiation and a third group who went with “active monitoring,” undergoing treatment only if the cancer progressed.

“I can counsel patients better now,” study author Freddie C. Hamdy, MD, of the University of Oxford, said in an interview with the New York Times. “I can tell them very precisely, ‘Look, your risk of dying from cancer is very, very small. If you receive treatment you will get some benefit. It will reduce the disease from growing outside your prostate, but these are exactly the side effects you might expect.’”

While 40 to 50 percent of prostate cancer patients in the U.S. now choose active monitoring—thanks to side effects from treatment like incontinence and diminished sexual function—patients who chose monitoring did see higher rates of cancer progression, either to distant parts of the body or nearby tissue outside the prostate.

While more of those monitored patients ended up having treatment as the study progressed, Hamdy said anxiety from physicians or the patients themselves, rather than evidence of progression, may have the deciding factor.

“We know that 80 percent of them had not shown signs of progression,” he said.

For more from patients who abandoned or stuck with their choice of active monitoring over treatment, click on the link below: