Observation of Prostate Cancer Deemed Safe

A new decision-analysis study showed that observation was superior to initial treatment for low-risk prostate cancer (PC) in terms of both cost and effectiveness.

Researchers at the Dana-Farber Cancer Institute (Boston, MA, USA), Massachusetts General Hospital (MGH, Boston, USA), and other institutions conducted a stimulated study to assess the costs and benefits of observation versus initial treatment for PC. The target population included men aged 65 and 75 years who had newly diagnosed low-risk PC. Treatment interventions included brachytherapy, intensity-modulated radiation therapy, or radical prostatectomy, while observation included active surveillance (AS) or watchful waiting (WW). The outcome measures were quality-adjusted life expectancy and costs.

The results showed that observation topped initial treatment for low-risk PC in terms of cost and effectiveness, with both AS and WW proving more effective and less expensive than immediate treatment. In a comparison of the two observation strategies, WW added 2 months of quality-adjusted life expectancy and saved USD 11,000-15,000 versus AS, depending on the patient's age. Initial treatment came out ahead of observation only under circumstances when it reduced PC mortality by more than 50%, with brachytherapy proving the most effective and least expensive initial treatment. The study was published early online on June 18, 2013, in Annals of Internal Medicine.

“We estimated that if the number of newly diagnosed men with low-risk prostate cancer who selected observation with watchful waiting increased from 10% to 50%, it would result in a cost savings of more than USD one billion,” said study coauthor Julia Hayes, MD, of the Dana-Farber Cancer Institute. “These findings provide further support for watchful waiting and active surveillance as reasonable and underused options for men with low-risk prostate cancer.”

AS involves close follow-up after diagnosis, typically with serial prostate-specific antigen (PSA) testing, digital rectal exam, and prostate biopsies. WW refers to a strategy of observing patients without monitoring and providing palliative care when PC becomes symptomatic. Mature data for AS suggest that 30% of men eventually require treatment for PC, while WW is historically reserved for men with less than 10 years' life expectancy or major comorbidities, and not expected to die of prostate cancer.

Related Links:
Dana-Farber Cancer Institute
Massachusetts General Hospital