Its trade-off is lively surveillance for prostate cancer. Available for men with low- and intermediate-grade prostate cancer, the procedure involves monitoring the boys's tumors with periodic biopsies and prostate-specific antigen (PSA) tests, and treating them only when — or If — the disease shows signs of progression.
Active surveillance allows men to avoid the unwanted side effects of invasive treatments similar to surgery or radiation (at the least for some time), but men often feel anxious enthusiastic about their cancer status because they'll't survive without treatment. Spend more time. Is there a middle ground between not treating cancer in any respect and aggressive treatment that may have long-lasting unwanted side effects? Emerging evidence suggests the reply could also be yes.
During a brand new publication Phase 2 clinical trial, researchers tested whether a drug called enzalutamide could delay cancer progression in men on lively surveillance. Enzalutamide interferes with testosterone, a hormone that drives prostate tumors to grow and spread. Unlike other treatments that block hormone synthesis, enzalutamide blocks testosterone from interacting with its cellular receptor.
A complete of 227 men were enrolled within the study. The investigators randomized half of them to each day enzalutamide treatment plus lively surveillance and the opposite half to lively surveillance alone. After nearly two years of follow-up, the investigators compared the outcomes of the 2 groups.
Results showed advantages from enzalutamide treatment. Specifically, tumor biopsies showed evidence of cancer progression in 32 of the treated men, compared with 42 men who didn't receive the drug. Men treated with enzalutamide were 3.5 times more more likely to haven't any cancer in at the least some biopsy samples. And it took six months longer for treated men to have PSA levels rise (a sign that the cancer is growing), in comparison with men who were just on lively surveillance.
Enzalutamide was generally well tolerated. The commonest unwanted side effects were fatigue and breast enlargement, each of which reversed when men stopped treatment.
together EditorialSusan Halabi, a prostate cancer statistician at Duke University, called the info encouraging. But Halabi also offered a cautionary note. Importantly, differences between the 2 groups were evident only in the course of the first yr of follow-up. By the top of the second yr, symptoms of exacerbations within the treated and untreated groups were “very similar,” he wrote, suggesting that enzalutamide was helpful only so long as the boys stayed on the drug. Longer studies of a decade or more could also be mandatory to find out whether early enzalutamide therapy changes the course of the disease, similar to requiring more invasive treatment in some men, Halabi added. It could also be delayed or prevented.