Avoiding Treatment for Prostate Cancer
27 April 2005
Early results, published today, from a study undertaken at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, suggest that many men with prostate cancer can safely avoid the need for treatment.
Eighty men whose small cancers were detected early as a result of prostate specific antigen (PSA) testing were given ‘active surveillance’, a new approach which individualises therapy by monitoring patients and selecting only those men with significant cancers for curative therapy.
Only 14 per cent of patients who took part in the study of ‘active surveillance’ received any treatment for their cancer, which means that the remainder have avoided the risks of treatment side-effects, such as impotence and incontinence.
By the age of 65 about half of all men will have some cancer cells in the prostate, but most will live out their natural span without the disease ever causing them any ill effects. However it is not possible to accurately predict cancer behaviour in an individual, so until now treatment has been typically offered to all men diagnosed with prostate cancer.
Active surveillance aims to target treatment only to those men who need it. Patients are closely monitored using serum PSA levels with or without repeat prostate biopsies. The choice between radical treatment and observation is based on evidence of disease progression defined in terms of the PSA doubling time (PSADT) or ‘upgrading’ at repeat biopsy.
Compared with a policy of immediate treatment in all cases, it is hoped that ‘active surveillance’ will reduce the burden of treatment side effects without compromising survival.
Dr Chris Parker of The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust said: ‘Prostate cancer is the only human cancer which is curable but which commonly does not need to be cured. The preliminary results of this study suggest that active surveillance is a feasible approach to managing early prostate cancer with the majority of patients avoiding the need for treatment.’
Prostate cancer is now the most common cancer to affect men in the UK, 30,000 cases are diagnosed each year and the disease kills 10,000 men a year.
A prospective study is now ongoing at The Royal Marsden NHS Foundation Trust, with the support of the National Cancer Research Institute, which aims to optimize the active surveillance protocol.
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For more information, or to arrange interviews, please contact:
Victoria Rae or Emma Hayes
The Institute of Cancer Research
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Lucy Twitchin, Press Officer
The Royal Marsden NHS Foundation Trust
Tel: 0207 808 2605
Notes to editors
This work was undertaken at The Royal Marsden NHS Foundation Trust, which received a proportion of its funding from the NHS Executive. This work was supported by The Institute of Cancer Research, the Bob Champion Cancer Trust, Cancer Research UK and NCRI South of England Prostate Cancer Collaborative.
The study consisted of eighty men with early prostate cancer who began active surveillance between 1993 and 2002. Eligibility included histologically confirmed prostatic adenocarcinoma, fitness for radical treatment, clinical stage T1/T2, N0/X, M0/X, a prostate specific antigen (PSA) level of ≤20 ng/mL, and a Gleason score of ≤7.
At a median follow-up of 42 months, 64 (80%) of the 80 patients on AS remained under observation, 11 (14%) received radical treatment and five (6%) died from other causes. No patient developed evidence of metastatic disease, none started palliative hormone therapy, and there were no deaths from prostate cancer. Of the 11 patients who received radical treatment all remained biochemically controlled with no clinical evidence of recurrent disease.
This research is to be published on April 27th 2005 in the British Journal of Urology.
June is Everyman Male Cancer Awareness Month. Everyman is The Institute of Cancer Research’s campaign to raise awareness of, and funds for research into, male cancer. For a free leaflet or information on how to help the Everyman Campaign call 0800 7319468 or logon at www.icr.ac.uk/everyman
The Royal Marsden Hospital together with The Institute of Cancer Research forms Europe’s largest cancer centre.
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