European Association of Urology
Men over 60 with low-risk prostate cancer could go ten years without active treatment and have a better sex life as a result, yet are very unlikely to die from the disease, it has found a new investigation.
The findings come from two new studies looking at ’active surveillance’ of prostate cancer, when the disease is closely monitored but not treated, presented today at the European Association of Urology congress, EAU21 .
The first uses data from Sweden’s National Prostate Cancer Registry, which has information on virtually all men diagnosed with the disease in that country since 1998, of whom 23,649 underwent active surveillance.
Active surveillance was introduced 15 to 20 years ago for men with low-risk prostate cancer, so so far there is no data on the risks and benefits over a longer period of time. The researchers, from Uppsala University and the University of Gothenburg, devised a new statistical technique to fill this gap.
Instead of simply looking at the number of patients on active surveillance who died from prostate cancer, they identified how many transitioned from active surveillance to other treatments, such as radiation therapy or surgery. Because these treatments have been provided for many years, there is already long-term follow-up data on them.
This allowed the researchers to model the likely outcomes for men on active surveillance up to 30 years after diagnosis, based on the numbers who transition to different treatments. They were able to show not only the percentage of men who would die from the disease during that period, but also the number of years they would go without treatment, after diagnosis.
Eugenio Ventimiglia, a urologist at San Raffaele Hospital in Milan, Italy, and a doctoral student in the Department of Surgical Sciences at Uppsala University, Sweden, explained: "We wanted to identify the real winners of active surveillance, the men who are probably not They die from prostate cancer, but they will also spend most of their remaining years without treatment if the disease is carefully controlled.
"Obviously, the older the age and the lower the risk of cancer, the greater the benefit. But we saw a real split at age 60. Men diagnosed under age 60 on active surveillance have a higher chance of dying from prostate cancer with very little additional benefit, in terms of additional years without other treatment. After sixty, if your cancer is low risk, then active surveillance is really a win-win: the model showed that men went ten years or more without another treatment with only a low percentage chance of dying from the disease.
Low impact on sexual function
Other treatments for prostate cancer, such as radiation therapy or surgery, can cause incontinence and erectile dysfunction, while the physical side effects of active surveillance are minimal. Other research presented today at EAU21 found that men on active surveillance report fewer problems with sexual function than those receiving other treatments.
The research is based on data from the EUPROMS (Europa Uomo Patient Reported Outcome Study), the first prostate cancer quality of life survey conducted by patients for patients.
Just under 3,000 men from 24 European countries diagnosed with prostate cancer have completed the survey at home on their own time. This allows them more time to consider their answers and report how they really feel, compared to questionnaires conducted in a clinical setting.
The survey showed that less than 45 percent of men on active surveillance reported problems getting an erection, compared to 70 to 90 percent of men on other treatments.
Lionne Venderbos, postdoctoral researcher at Erasmus MC, Rotterdam, who analyzed the survey results, said: "Lack of sexual function affects patients’ quality of life more than any other reported side effect. The survey shows that active surveillance has the least impact on sexual function of all possible treatment options.
"It is important for men diagnosed with prostate cancer to consider this before deciding which treatment option to pursue. Men who choose active surveillance as their preferred option have the same five-year survival rates as those who chose active surveillance." surgery or radiation, can also maintain sexual function.
Hendrik Van Poppel, professor emeritus of urology at Katholieke Universiteit Leuven, Belgium, and member of the EAU Executive, said: "When men diagnosed with prostate cancer are deciding their treatment option, quality of life is often the most important factor.
As these studies show, active surveillance has the least negative impact, but that treatment option is only possible when the disease is diagnosed at an early stage. It is vital to detect this disease early, and the option of active surveillance should encourage men to overcome their reluctance to be tested for prostate cancer. Prostate cancer can be fatal, but also the later the diagnosis, the more severe the treatments and the greater the impact on quality of life."
