Management of low (favourable)-risk prostate cancer

Abstract

What's known on the subject? and What does the study add? Most men who are diagnosed with favourable-risk prostate cancer undergo some form of active intervention, despite evidence that treatment will not improve health outcomes for many. The decision to undergo treatment after diagnosis is, in part, related to the inability to precisely determine the long-term risk of harm without treatment. Nevertheless, physicians should consider patient age, overall health, and preferences for living with cancer and the potential side effects of curative treatments, before recommending a management option. This is especially important for older men, given the high level of evidence that those with low-risk disease are unlikely to accrue any benefit from curative intervention. What is known on the subject: Over treatment of favourable-risk prostate cancer is common, especially among older men. What does the study add: A review of the natural history of favourable-risk prostate cancer in the context of choices for management of the disease. • The management of favourable-risk prostate cancer is controversial, and in the absence of controlled trials to inform best practice, choices are driven by personal beliefs with resultant wide variation in practice patterns. • Men with favourable-risk prostate cancer diagnosed today often undergo treatments that will not improve overall health outcomes. • A shared-decision approach for selecting optimal management of favourable-risk disease should account for patient age, overall health, and preferences for living with cancer and the potential side effects of curative treatments.

FIG. 1

Age-specific percentage distribution of men with low-risk prostate cancer by type of initial management in 2002. Data from Patterns of Care Study conducted by Surveillance, Epidemiology and End Results Program (SEER) of the National Cancer Institute (NCI). Low risk defined as Gleason score < 7 and a PSA level of ≤ 10 ng/mL. BT (brachytherapy), EBRT (external beam radiotherapy), PADT (primary ADT), WW (watchful waiting). Adapted from Hamilton et al. [24] .