their prostate cancer.
“The fact that the greater progression of disease seen under active monitoring didn’t translate into higher mortality will be both surprising and encouraging to urologists and patients,” Dr. Peter Albers, a urologist at Dusseldorf University and chair of the European Association of Urology’s Scientific Congress, said in a meeting news release.
“Active monitoring and biopsy protocols today are much more advanced than at the time this trial was conducted, so it’s possible we could improve on these outcomes still further. It’s an important message for patients that delaying treatment is safe, especially as that means delaying side effects as well,” according to Albers.
Patients from all three groups reported a similar overall quality of life, but the negative effects of treatment on urinary, bowel and sexual function persisted much longer than previously thought.
Men who underwent surgery or radiation therapy suffered from incontinence, impotence and other side effects for up to 12 years, researchers said.
“Surgery can lead to reduction in sexual function as well as urine leakage, which may require one in five men to wear pads for protection,” Donovan says. “Radiotherapy leads to a decline in sexual function, and also some fecal leakage can occur.”
The clinical trial also highlighted flaws in the screening methods used to predict which prostate cancers are likely to grow quickly and spread.
Initially, about three out of four (77 percent) of the participants were deemed to have low-risk cancer, but a reassessment using more modern methods showed that a far greater number would now be considered to have intermediate-risk cancer.
In fact, in about 30 percent of the men their cancer had already spread beyond the prostate.
Dahut notes that monitoring of diagnosed prostate cancers has vastly improved since this trial started, and is much more sophisticated these days.
“We’ve evolved a little bit from the term ‘watchful waiting’ to the term ‘active surveillance,'” Dahut says. “It’s a very active process now where you’re monitoring the cancer and if there are changes of concern, then you reassess whether intervention is needed. Today, we would monitor them more intensively, oftentimes using MRI.”
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Talking with your doctor
It’s important to discuss your options and possible pros and cons, with your doctor. He or she can help you choose one you are comfortable with. The following factors might will help determine which option is best for you:
- Your age and overall health
- The likelihood that you have prostate cancer (based on tests done so far)
- Your own comfort level with waiting or getting further tests