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Prostate cancer treatment can wait for most men, study finds


Researchers have found long-term evidence that active surveillance for localized prostate cancer is a safe alternative to surgery or immediate radiation therapy.

The results, released Saturday, are encouraging for men who want to avoid treatment-related sexual and incontinence problems, said Dr. Stacy Loeb, a prostate cancer specialist at NYU Langone Health who was not involved in the study. research.

The study directly compared the three approaches – surgery to remove tumors, radiation therapy and monitoring. Most prostate cancers grow slowly, so it takes many years to examine the results of the disease.

“There was no difference in prostate cancer mortality at age 15 between the groups,” Loeb said. And prostate cancer survival for all three groups was high – 97% regardless of treatment approach. “This is also very good news.”

The findings were published Saturday in the New England Journal of Medicine and presented at a European Association of Urology conference in Milan, Italy. The UK’s National Institute for Health and Care Research funded the research.

Men diagnosed with localized prostate cancer shouldn’t panic or rush treatment decisions, said lead author Dr Freddie Hamdy of the University of Oxford. Instead, they should “carefully consider the possible benefits and harms caused by treatment options.”

A small number of men with high-risk or more advanced disease need urgent treatment, he added.

The researchers followed more than 1,600 British men who agreed to be randomly assigned to undergo surgery, radiotherapy or active surveillance. The patients’ cancer was confined to the prostate, a walnut-sized gland that is part of the reproductive system. The men in the monitoring group underwent regular blood tests and some underwent surgery or radiation therapy.

Death from prostate cancer occurred in 3.1% of the active surveillance group, 2.2% in the surgery group and 2.9% in the radiotherapy group, differences considered statistically insignificant.

At age 15, the cancer had spread in 9.4% of the active surveillance group, 4.7% of the surgery group and 5% of the radiotherapy group. The study began in 1999 and experts said current monitoring practices are better, with MRI imaging and genetic testing guiding decisions.

“We now have more ways to help detect that the disease is progressing before it spreads,” Loeb said. In the United States, about 60% of low-risk patients choose surveillance, now called active surveillance.

Hamdy said researchers had seen the difference in cancer spread at 10 years and expected it to make a difference in survival at 15 years, “but it doesn’t.” He said spread alone does not predict death from prostate cancer.

“This is a new and interesting finding that is useful for men when making treatment decisions,” he said.

The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute Science and Education Media Group. The AP is solely responsible for all content.

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