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More men in the United States deal with prostate cancer surgery



More men in the United States deal with prostate cancer surgery

(HealthDay) – Much more American men now say no to low-risk prostate cancer surgery and choose to follow the disease instead, a new study found.

In just five years, researchers found that the number of men who opted for monitoring tripled – from 14% of patients in 2010 to 42% in 2015

The change followed the new guidelines recommending "active surveillance" as an option for men with low risk prostate cancer. This refers to small, slowly growing tumors that are unlikely to progress to the point of threat to human life.

Active surveillance includes periodic blood tests and studies, and possibly biopsies to see if the cancer progresses. Treatment can ultimately be recommended or never needed.

Cancer experts said the tide is good news.

"In medicine, the change usually happens very slowly," says Dr. Len Liechtenfeld, principal physician at the American Cancer Society. – So I think this is a very rapid change we see. I think it's remarkable.

Liechtenfeld, who did not participate in the study, said that his "hat was excluded" for doctors who accepted the change.

Prostate cancer is an honor: men in the United States have about one chance of being diagnosed with the disease, according to the cancer community. However, prostate cancer is often slowly growing and may never progress significantly.

Research shows that if a person lives long enough, he is likely to develop a prostate tumor, Liechtenfeld said. Years ago, he explained, much older men unknowingly had the disease – because they "never influenced them" – and died for other reasons.

But then came the era of prostate-specific antigen (PSA) screening, and the number of men in the United States diagnosed with small prostate tumors shot up. Initially, most of these men had surgery to remove the prostate gland.

And this treatment carries risks, including persistent incontinence and sexual dysfunction.

"We" treated "many men who should not have been cured," Liechtenfeld said.

Now things are changing, says Dr. Brandon Mahal, the lead investigator of the new study.

The purpose of active surveillance, he said, is to help men with low-risk cancers to avoid unnecessary side effects of treatment.

"These patients should at least discuss active surveillance with their physician and discuss it," Mahal said. He is a radiation oncologist at the Dana-Farber Cancer Institute / Brigham Hospital and the women in Boston.

Liechtenfeld agreed. "Some men will still decide," I want this from me, "and they will opt for surgery, but others will be happy to opt for active surveillance," he said.

"The important thing," Liechtenfeld added, "is that there is a careful conversation about the possibilities. I do not feel as if you have to hurry to the treatment.

The results, published online on February 11, 2009, Journal of the American Medical Associationare based on a government database on cancer. It includes information about nearly 165,000 men in the United States diagnosed with early prostate cancer that is confined to the gland.

Among men with a low risk of cancer, the rate of surgery, as their initial treatment declined from around 47% in 2010 to 31% in 2015. The radiotherapy rate declined from 38% to just under 27%.

By 2015, the latest available data, 42% of these patients chose active surveillance. But is this percentage "high enough?"

"It is definitely encouraging to see it being used more often," says Dr. James Eastham, head of urology at the Memorial Sloan Kettering Cancer Center in New York. "But there is room for improvement.

This improvement may happen: Eastham said it is likely that the rate of active surveillance will continue to rise from 2015 onwards.

He noted that not only doctors change their practice but also because patients are more open to active surveillance. "Patients are getting more comfortable," says Eastham.

According to Mahal, the long-term question remains: How will active monitoring finally lead to the quality of life and longevity of men?

Since men can live with low-risk prostate cancer for a long time, Lichtenfeld said, it would take years, if not decades, to understand.

"We still do not have all the answers," he said.


The study found an increase in "active surveillance" for low-risk prostate cancer


More information:
Brandon Mahal, Doctor of Science, Radiation Oncology Division, Dana-Farber Cancer Institute / Brigham & Women Hospital, Boston; Len Liechtenfeld, Chief Doctor, American Cancer Society, Atlanta; James Eastham, Chief Doctor of Urology, Memorial Sloan Catering, New York; February 11, 2019, Journal of the American Medical Association, online

American Cancer Society has more to treat prostate cancer.

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More men in the United States are behaving in a prostate cancer surgery (2019, February 12)
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