Patients With Low-Risk Prostate Cancer on Active Surveillance Experience Good Quality of Life
Active surveillance has become an increasingly important alternative to surgery, chemotherapy, or radiation treatment for men diagnosed with low-risk prostate cancer. However, what is the impact of active surveillance on health-related quality of life in patients selected or opting for this conservative form of disease management? New research published by Pham et al in The Journal of Urology found that patients on active surveillance who were tracked for 3 years experienced similar health-related quality of life as men without prostate cancer, both clinically and psychologically.
The majority of men diagnosed with prostate cancer have low-risk disease and face a difficult decision between having the disease managed conservatively through active surveillance or undergoing definitive therapy. These results can help guide physicians and patients through this decision-making process.
“To our knowledge, this is the first report of health-related quality-of-life outcomes of men on active surveillance for prostate cancer compared to men without prostate cancer in a prospective, multi-institutional study,” explained lead investigator Christopher R. Porter, MD, FACS, of the Virginia Mason Medical Center in Seattle, Washington. “The potential clinical impact of these results is significant and will allow clinicians to counsel patients effectively in regard to the potential health-related quality-of-life outcomes associated with active surveillance.”
Although the lifetime risk of a prostate cancer diagnosis is about 1 in 6, the lifetime risk of death from the disease is 1 in 30. Management of low-risk prostate cancer with active surveillance appears feasible and safe, yet most men in the U.S. with low-risk disease still undergo definitive therapies such as radical prostatectomy, which carry the burden of urinary, bowel, and sexual dysfunction that can be avoided, or at the very least postponed, with management on active surveillance.
Study Findings
Using data compiled from four military medical centers participating in the Center for Prostate Disease Research Multicenter National Database, researchers analyzed patient-reported health-related quality of life using validated metrics derived from two questionnaires, one dealing specifically with prostate cancer-related outcomes and a second focusing on general health assessment. The racially diverse study sample consisted of two groups: 89 patients diagnosed with low-risk prostate cancer (clinical stage T1–T2a, biopsy Gleason score 6 or less, and prostate specific antigen less than 10 ng/mL), who initially underwent active surveillance, and 420 patients without cancer who had a negative prostate needle biopsy.
With the exception of a slight difference in bowel function, investigators found that health-related quality-of-life outcomes for patients on active surveillance were no different than those in men without prostate cancer during the 3 years of follow-up.
“Our results suggest that for at least 3 years, men selecting active surveillance do not experience a substantial psychological burden or clinically significant problems due to untreated disease. This study provides important data that can be used to inform comparable patients when considering management options for low-risk prostate cancer,” noted Dr. Porter.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
