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Research shows benefit of active surveillance for prostate cancer patients

Scientists at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust found that placing patients with low-risk localised prostate cancer onto 'active surveillance' — where their prostate is closely monitored for any progression of their disease — was as effective as more radical treatments.

The team found that in 471 patients with localised prostate cancer, active surveillance allowed nearly 70% of men to avoid treatment during their first five years of diagnosis, and that survival rates for patients receiving active surveillance compared favourably with patients given immediate treatment.

Prostate cancer can be deadly, but in men whose disease is classed as low risk, it may never cause any symptoms or progress further, and so may never need treatment. Active surveillance could therefore prevent these men from receiving unnecessary treatment, with its potential side-effects.

Researchers at The Institute of Cancer Research (ICR) and The Royal Marsden studied 471 men with low-risk localised prostate cancer who chose active surveillance rather than immediate treatment. Patients were given rectal exams regularly, together with tests to monitor their levels of prostate specific antigen (PSA), a warning sign for prostate cancer; every two years the patients' tumours were also biopsied. Patients were switched from active surveillance to radical treatment if their PSA levels increased too rapidly or if their biopsy showed their cancer was getting worse.

The researchers found that the chance of patients remaining treatment free after two years of active surveillance was 89%. After five years, 69% of patients were still on active surveillance while 31% were switched to some form of treatment for their prostate cancer. To date, 2 of the 471 men have died from prostate cancer, a figure that is comparable to that after immediate treatment.

Dr Chris Parker, Consultant Clinical Oncologist at The Royal Marsden and Reader in Prostate Oncology at The Institute of Cancer Research, said: "Our study shows that active surveillance is an attractive management option for men with low-risk localised prostate cancer and that it could help more men to avoid radical treatments.

"We found that active surveillance allowed 70% of men to avoid treatment for low-risk localised prostate cancer for five years, and so far we've seen no difference in the long term risk of death for active surveillance compared with immediate treatments like radiotherapy and surgery.

"What’s more, active surveillance avoids the potential side-effects from these treatments which can include erectile dysfunction, and incontinence. In the UK, around 40% of men with low-risk localised prostate cancer receive active surveillance but it could be used even more widely."

The study, published in the journal European Urology, was funded by the NHS Executive and the ICR and The Royal Marsden NHS Foundation Trust's joint NIHR Biomedical Research Centre for Cancer.

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