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More men opting for prostate cancer surveillance over treatment

Last updated on October 6, 2019

A new study from The Journal of the American Medical Association (JAMA) shows men with early-stage prostate cancer are opting out of treatment and are instead, opting for regular monitoring.

According to the American Cancer Society (ACS), one in seven men will be diagnosed with prostate cancer during his lifetime.

The US Centers for Disease Control and Prevention says that many men with tumors confined to the prostate do not die of cancer and are also unlikely to have symptoms.

Doctors have seen a spike in the amount of men who are choosing active surveillance or watchful waiting among those with localized prostate cancer. Men who experience a progression in the disease undergo treatment, but the rest are undergoing surveillance.

From 1990 to 2009 surveillance in men with low-risk cancer ranged from 7 to 14 percent, but between 2010 and 2013, the numbers have increased to 40 percent. While there are several possible treatments for prostate cancer including radiation and surgery, more men, especially those who are older, are opting for surveillance.

“This is progress in the right direction,” said lead author Dr. Matthew Cooperberg of the University of California, San Francisco.

The American Cancer Society explains that men who chose active surveillance can undergo biopsies or tests to make sure the cancer is not growing, which is an approach that helps avoid more aggressive treatments. Such aggressive treatments can sometimes leave men with complications such as impotence and incontinence.

The ideal rate of active surveillance for low-grade disease isn’t clear, Cooperberg told Reuters Health, but “it’s probably higher than 40 percent.”

Among men age 75 or older, 76 percent opted for surveillance from 2010 through 2013, researchers found.

With more men opting for the surveillance method for their prostate cancer, researchers are hoping it will reopen the discussion on PSA screening. This screening measures blood levels of prostate-specific antigen (PSA), which are often high in men with prostate cancer.

One argument against PSA screening is that men may go on to have aggressive treatment for cancer that might never have caused them problems.

“Our hope is that these findings and other papers with similar findings will really start to reopen the question on early detection and screening,” Cooperberg said.

The American Urological Association recommends against PSA screening in men younger than 40. It does not recommend routine screening between ages 40 and 54, or after age 70 for men with less than a 10 to 15 year life expectancy. It recommends that men ages 55 to 69 decide about PSA testing after discussions with their doctors.

Currently, the government-backed U.S. Preventive Services Task Force (USPSTF) recommends against screening for PSA levels.