Men with Favorable Intermediate-Risk Prostate Cancer May Also Be Candidates for Active Surveillance

Ann Caroline Raldow, M.D. Brigham and Women's Hospital Resident in Radiation OncologyMedicalResearch.com Interview with:
Ann Caroline Raldow, M.D.
Brigham and Women’s Hospital
Resident in Radiation Oncology

Medical Research: What is the background for this study? What are the main findings?

Dr. Raldow: Active surveillance (AS) means monitoring the course of prostate cancer (PC) with the expectation to start treatment if the cancer progresses. Men who enter an AS program are able to defer and possibly avoid the side effects of prostate cancer treatment.

According to the National Comprehensive Cancer Network (NCCN) guidelines, active surveillance is currently considered as an initial treatment approach for men with low-risk PC and a life expectancy of at least 10 years. However, no direct comparison has been made between favorable intermediate-risk and low-risk PC with regard to PC-specific mortality or all-cause mortality following treatment with high-dose radiation therapy such as brachytherapy, where radioactive seeds are placed inside the prostate to kill the cancer. We therefore assessed whether the risks of prostate cancer-specific mortality and all-cause mortality following brachytherapy were increased in men with favorable intermediate-risk versus low-risk prostate cancer. The study consisted of more than 5,000 men who were treated with brachytherapy at the Prostate Cancer Foundation of Chicago.

After a median follow-up of 7.69 years, there were no significant differences in prostate cancer-specific mortality and all-cause mortality between men with low-risk and favorable intermediate-risk prostate cancer, suggesting that men with favorable intermediate-risk prostate may also be candidates for AS.

Medical Research: What should clinicians and patients take away from your report?

Dr. Raldow: Our results suggesting no significant difference in the risks of PCSM and ACM in men with low-risk and favorable intermediate-risk prostate cancer should be interpreted cautiously because they are not based on data from a randomized clinical trial. In addition, showing a nonsignificant difference in the risk of prostate cancer-specific mortality amongst men with favorable-intermediate risk prostate cancer versus low-risk prostate cancer who were treated is not equivalent to showing nonsignificant results among men in similar risk groups who undergo AS. However, while awaiting the results from a randomized clinical trial, our results provide evidence to support Active surveillance as an initial approach for men with favorable intermediate-risk prostate cancer.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Raldow: The best evidence to support or refute Active surveillance in men with favorable-intermediate risk prostate cancer will come from the randomized ProtecT trial, the randomized trial of AS versus treatment. The ProtecT trial is scheduled to report its initial findings in 2016.

Citation:

MedicalResearch.com Interview with: Ann Caroline Raldow, M.D. (2015). Men with Favorable Intermediate-Risk Prostate Cancer May Also Be Candidates for Active Surveillance 

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