By Henry L. Davis
NEWS MEDICAL REPORTER
January 09, 2010, 6:26 AM
The National Comprehensive Cancer Network has announced that it has updated its practice guidelines for physicians to stress active surveillance rather than treatment for many men with low-risk prostate cancer.
Roswell Park Cancer Institute played a key role in the new recommendations, with three physicians serving on the network’s 23-member guideline panel, including Dr. James Mohler, who led the group.
A big change in the guidelines is the recommendation for active surveillance instead of treatment for men with very-low- risk prostate cancer and a life expectancy estimated at less than 20 years, and for men with low-risk prostate cancer and a life expectancy of less than 10 years. The very-low-risk category is new and represents patients with what’s considered “insignificant” prostate cancer.
The new guidelines reflect the debate in medical circles over what is the most appropriate action to take with early-stage prostate cancer.
The problem starts with the PSA test to detect prostate cancer. It can’t tell the difference between harmless tumors and those that will grow into dangerous cancers but has led to suspected tumors being diagnosed much earlier, leading many patients to rush into unnecessary therapies that drive up costs and risk complications.
The other dilemma for the 192,800 men who will be diagnosed with prostate cancer this year is that each therapy, such as surgery and radiation, has its advocates, as well as its pros and cons. But it’s unclear which one is best. The federal Agency for Healthcare Research and Quality in 2008 concluded that not enough scientific evidence exists to identify a treatment as most effective at prolonging life or limiting such side effects as incontinence.
Active surveillance is considered an option because prostate cancer is generally slow-growing. Experts estimate that 40 percent of patients 65 and older will die of other causes before their cancer requires treatment.
Active surveillance involves monitoring the disease and intervening if the cancer progresses. Patients in active surveillance should obtain regular prostate exams and PSA tests, according to the guidelines.
“Growing evidence suggests that overtreatment of prostate cancer commits too many men to side effects that outweigh a very small risk of prostate cancer death,” Mohler, chairman of urology at Roswell Park, said in a statement.
The National Comprehensive Cancer Network panel reviewed data showing that 23 percent to 42 percent of all prostate cancers detected in the United States by PSA tests and digital rectal exams are overtreated.
Despite the greater emphasis on active surveillance, Mohler said final decisions on care should be based on a careful review of a patient’s particular situation, including life expectancy, disease characteristics, general health condition, potential side effects of treatment and the patient’s preferences.
Drs. Robert Huben, chief of urology at Roswell Park, and Michael Kuettel, chairman of radiation medicine, also served on the panel.
The head of one of the leading prostate cancer advocacy groups praised the changes in the guidelines. “The recognition of active surveillance in recent years has been a good development,” said Thomas Kirk, president and chief executive officer of US TOO International, a network of more than 300 support groups around the world, including Buffalo. Source:http://www.buffalonews.com
