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Why are there more patients with low-risk prostate cancer who are not receiving treatment?



According to a study published in the medical journal, among men with low-risk prostate cancer in the United States, 42.1% used the surveillance and waiting method, also called "active surveillance", in 2015, compared to to 14.5% registered in 2010. JAMA on Monday.
Compared to high risk or intermediate risk, low-risk prostate cancer tends to grow very slowly or does not grow at all, so "active surveillance" can be considered as an alternative to treatment options, such as surgery or radiotherapy. Surgery and radiation therapy can have some side effects, including an increased risk of erection or urination problems or accidental leaks.

According to the study, as the use of active surveillance increased between 2010 and 2015, it became the most common approach to treating low-risk prostate cancer.

"We found that in low-risk prostate cancer, the use of active surveillance nearly tripled," said Dr. Brandon Mahal, a clinical investigator in radiation oncology at the Dana-Farber Cancer Institute at Harvard University in Boston and first author of the study.

"In general, these numbers are a good sign and a good thing," he said. "From 2010 to 2015, there have been many new tests, the highest level of evidence we can obtain in medicine, which are prospective trials and some of them randomized trials, which have shown that active surveillance, conservative approaches or not approaches of low-risk prostate cancer treatment have very favorable results. "

& # 39; This study is really the point of reference & # 39;

Throughout the world, prostate cancer is the second most common cancer among men. There were 1.3 million new cases of prostate cancer in 2018, according to the Global Fund for Cancer Research.
According to the National Cancer Institute, in the United States, approximately 11.2% of men will be diagnosed with prostate cancer at some point in their lives.
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The new study included data on 164,760 men diagnosed with prostate cancer in the United States between 2010 and 2015. The data, which came from the database of Surveillance, Epidemiology and Final Results, included information on the treatment approach of each man .
The researchers found that, among men with low-risk disease, the use of active surveillance increased while the use of radical prostatectomy, or removal of parts of the prostate gland, decreased from 47.4% in 2010 to 31.3% in 2015. Use The researchers found that radiation therapy also decreased, from 38% in 2010 to 26.6% in 2015.

Among men with intermediate-risk disease, between 2010 and 2015, active surveillance increased from 5.8% to 9.6%; Prostatectomy decreased from 51.8% to 50.6%; The researchers found that radiotherapy went from 42.4% to 39.8%.

Among men with high-risk disease, active surveillance remained almost unchanged, from 1.9% to 2.2%; Prostatectomy increased from 38% to 42.8%; The researchers found that radiation therapy decreased from 60.1% to 55%.

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The study had some limitations, including the fact that it analyzed trends only within a period of five years. More research is needed to determine trends over a longer period of time and how those trends can affect public health. The study also lacked data on whether patients actually complied with their doctors' orders about active surveillance or other management approaches.

However, in general, "this study is really the benchmark for surveillance rates in the United States," said Mahal.

"There were other studies that examined the same question and found increasing rates, but those studies were done with smaller databases or with databases that did not collect this type of information," he said. "In addition, it is important to follow these trends to know with certainty what are the rates of administration in the US, and also to know in the population, what patients do in active surveillance."

& # 39; A major change in medical practice & # 39;

A study published in JAMA last year found that the use of a conservative approach to cancer control, including active surveillance, increased from 27% in 2005 to 72% in 2015 among men with low-risk prostate cancer in Veterans Affairs integrated health care system that was less than 65 years old and from 35% in 2005 to 79% in 2015 among those over 65 years of age.
"It is very encouraging that the proportion of men receiving conservative treatment for low-risk prostate cancer has increased over time, but there seems to be a long way to go," said Dr. Stacy Loeb, urologist and assistant professor of urology and population health at NYU Langone Health in New York.
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"For anyone in the low-risk prostate cancer category, what we now know is that the prognosis is pretty good even without any treatment," said Loeb, who was not involved in the new research but was the first author of the study. from last year.

When it comes to radiation or prostatectomy, "these treatment options have potential side effects, such as the impact on erectile function, urination and, in some cases, bowel function," he said. "Therefore, it is an attractive option for men to control cancer and then receive delayed treatment as needed, if it appears over time that the cancer is becoming more aggressive."

The new study reflects how the medical community continues to grow in its understanding of how to best treat certain types of cancer, said Dr. J. Leonard Lichtenfeld, interim medical director of the American Cancer Society, who was not involved in the research.

"We have really come a long way to try to better understand how to detect prostate cancer and, once we detect prostate cancer, what is the best way to treat that prostate cancer and understand that not all men need to be diagnosed with prostate cancer. excise or radiate your prostate. "Lichtenfeld said.

"That does not mean they may never need radiation or surgery, the main objective of observing these men is to find out if prostate cancer changes its behavior over time, if it becomes more aggressive, then treat those who really need it." . "he said." That's a major change in medical practice. "


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