Prostate cancer can take an extended time to develop, and if a person's tumor has characteristics that predict slow growth, he may select energetic surveillance fairly than immediate treatment. Men on energetic surveillance have routine PSA blood tests and prostate biopsies, and are treated provided that the cancer grows or shows evidence of increased activity. But when it comes time for treatment, a 3rd of men still resolve against it. now, A new study It seems that treatment could be safely delayed for a few of these men.
Researchers on the University of California, San Francisco, identified 531 men whose cancers progressed while they were on energetic surveillance. All men were initially diagnosed with grade group 1 prostate cancer, the bottom on a grading scheme that ranks cancers from low to high risk of aggressive spread. Within 25 months, on average, the lads's biopsy specimens showed that that they had progressed to the higher-risk grade groups which can be typically treated.
In all, 192 men underwent surgery to remove the prostate inside six months of their tumor upgrading. But 125 men waited five years before the operation, and 214 men decided to not have treatment in any respect.
Results and observations
When researchers compared long-term outcomes between men who had surgery inside six months and people who waited longer to have their operation, they found little difference. Forty-five men in each groups had cancer return inside three years after surgery. But the share who avoid Cancer reoccurrence was similar in each groups: 80% of men within the early surgery group were still cancer-free after three years, compared with 87% of men who delay surgery for five years.
Furthermore, prostate tissue observed by a pathologist immediately after surgery showed similar rates of antagonistic biologic characteristics that predicted worse subsequent outcomes. Approximately half of the tumors in men in either group had this sort of negative pathology. Based on these findings, the authors concluded that “a subset of patients with biopsy progression can safely continue on active surveillance.”
The trick is to predict who those patients are. Unfortunately, genetic testing has provided some insight into which men may develop faster than others. The authors emphasize that more studies are needed to find out how genetic tests may help make treatment decisions for men on energetic surveillance. I An editorial commentDr. Christopher Morasch from the University of Ottawa cautioned that a three-year follow-up will not be long enough, and that differences between early and late surgery groups may emerge in the approaching years.