NEW YORK (Reuters Health) - Men with low-risk forms of prostate cancer are more likely to opt for so-called active surveillance over surgery or radiation when they have a multidisciplinary team of doctors working with them, according to a new study.
Researchers said that may be because teams with urology, imaging and cancer specialists can provide the most balanced view of the risks and benefits of different options.
Recent studies have suggested that for men who have low-risk cancers, active surveillance - which means bringing the patient back for regular checks but not operating immediately - may be just as effective as going straight to prostate surgery or radiation treatment following a diagnosis (see this Reuters Health story of July 18, 2012 reut.rs/NPmfPG)
That approach also means patients often avoid the side effects, such as incontinence and impotence, as well as the hefty price tags of unnecessary treatment. Prostate surgery, for instance, typically runs about $13,000.
“For most older men who have low-risk disease, the treatment is not going to change the outcome that we all think about, which is living the rest of their life without being harmed by prostate cancer,” said Dr. H. Ballentine Carter, a urologist from Johns Hopkins Medicine in Baltimore, who wasn’t involved in the new research.
About 240,000 men in the U.S. will be diagnosed with prostate cancer in 2012, according to the American Cancer Society. More than half of them will have low-risk cancers, which are slow growing and often don’t affect how long a man will live or cause him serious symptoms.
Still, more than nine in 10 men with prostate cancer opt for treatment including surgery or radiation, researchers noted in the new study, published Monday in the Journal of Clinical Oncology.
“Many patients who are diagnosed with cancer are over-diagnosed, which means they’re found to have something that doesn’t really pose a threat to their life,” said Dr. Laurence Klotz, head of urology at the Sunnybrook Research Institute in Toronto.
Up to half of all newly-diagnosed prostate cancer patients are candidates for active surveillance, Klotz, who also didn’t work on the new study, told Reuters Health.
“The multidisciplinary groups tend to enhance the degree to which a balanced view is presented to the patient,” Klotz added.
In contrast, urologists seeing a patient alone may recommend the procedure they know best - prostate surgery - whereas radiologists might push for radiation, researchers said.
For the new study, Dr. Jason Efstathiou from Massachusetts General Hospital and his colleagues analyzed treatment choices made by 701 men with low-risk prostate cancer seen at hospitals in Boston.
About one-third of them worked with multidisciplinary teams of doctors, and 43 percent of those patients ended up opting for active surveillance over immediate surgery or radiation. That compared to 22 percent of the men who saw individual practitioners and decided to go with a more conservative approach.
“There is no doubt that different environments could sway men toward different management decisions,” Efstathiou told Reuters Health.
“A multidisciplinary clinic visit allows the patient to hear multiple views regarding their disease and what could be appropriate management choices. We believe that it allows for greater informed decision-making,” he said.
Researchers said prostate cancer patients should be seen in medical centers that have multidisciplinary teams, if possible. But they can also talk with their doctors individually about less aggressive and immediate treatment options, and seek out second opinions.
“The very first question should be, ‘Do I need to get treatment or not?'” Carter said. “Then if they get beyond that point they can discuss treatment options.”
Klotz said about one-third of men who choose active surveillance will end up needing treatment because their cancers progress. But there’s no evidence those men are any more likely to die of the disease than men who get treated right away, he added.
“Instead of pulling the trigger so quickly… men need to understand that for the most part, prostate cancer is simply not an urgent situation,” Carter said.
SOURCE: bit.ly/gPtMdm Journal of Clinical Oncology, online July 30, 2012.