CANCER DIGEST – July 8, 2015 – A new analysis of national prostate cancer treatment trends shows that there has been a big shift away from aggressive treatment to watchful waiting and active surveillance for men diagnosed with prostate cancer since the early 1990s.
Watchful waiting avoids aggressive testing and watches for any physical symptoms of progressive disease. It is generally reserved for avoiding treatment altogether for older, sicker patients who will most likely die from something else. Active surveillance uses repeated PSA testing and prostate biopsies to monitor for development of more aggressive disease in younger, healthier patients who might benefit from delaying treatment.
The analysis included 10,472 men; average age, 66 years showed that surveillance used for low-risk disease increased from 7 percent to 14 percent between 1990 and 2009 to 40 percent between 2010 through 2013.
At the same time aggressive treatment with hormone blockade for intermediate-risk and high-risk tumors, which increased from 10 percent in 1990 to 30 percent in 2009 decreased sharply to 4 percent. The study appears in the July 7, 2015 Journal of the American Medical Association.
Among men 75 years or older, the rate of surveillance was 54 percent from 1990 through 1994, declined to 22 percent from 2000 through 2004, and increased to 76 percent from 2010 through 2013.
There was an increase in the use of surgery for men 75 years or older with low-risk cancer to 9.5 percent and intermediate risk cancer to 15 percent; however, there was not an increase in use for those with high-risk cancer, among whom androgen deprivation still accounted for 67 percent of treatment.
Substantial variation persisted in treatment patterns across individual practices, as observed previously.
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