Watchful waiting in the management of localized low-risk prostate cancer has risen sharply as “overtreatment” has fallen, suggesting an improvement in the management of the disease, according to a report in JAMA.
In the analysis of 10,472 men from 1990 to 2013, use of surveillance for low-risk disease rose sharply in 2010 through 2013, to 40% of cases. Use of surveillance had previously remained low, at between 7% and 14%, from 1990 through 2009.
Dr. Matthew Cooperberg did the study with Dr. Peter Carroll, both of the University of California, San Francisco, to analyze recent trends in community-based patterns of managing localized prostate cancer.
Data from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) were used. This is a national registry of men with prostate cancer cared for since 1995 across 45 US urology practices.
The study included men with tumors classified as stage cT3aNoMo or lower managed with prostatectomy, radiation, androgen deprivation monotherapy, or active surveillance/watchful waiting between 1990 and 2013.
While watchful waiting rose, rates of treatment with androgen deprivation for intermediate-risk and high-risk tumors fell.
This form of management had been rising steadily from 1990 (10% and 30% for intermediate- and high-risk respectively), but fell sharply from 2010 (to 4% and 24%, respectively).
The rise in opting for surveillance also happened among men of 75 years of age or older, although after a dip. This rate was 54% from 1990 through 1994, 22% from 2000 through 2004, and 76% from 2010 through 2013.
There was an increase in the use of surgery for men aged 75 years or older with low-risk cancer, to 9.5%, and intermediate-risk cancer, to 15%.
There was no increase in opting for surgery, however, for those with high-risk cancer, among whom androgen deprivation still accounted for 67% of treatment.
The authors believe the trends may result in changes to approaches for the cancer mostly affecting older men:
“Given that overtreatment of low-risk disease is a major driver of arguments against prostate cancer screening efforts, these observations may help inform a renewed discussion regarding early detection policy in the United States.”
They add: “The magnitude and speed of the changes suggest a genuine change in the management of patients with prostate cancer in the United States, which could accelerate as more clinicians begin to participate in registry efforts.”