Patients Diagnosed With Low-Risk Prostate Cancer Can Delay Treatment, Study Finds


Deciding on the appropriate treatment following a prostate cancer diagnosis is an extremely personal matter and should involve an informed decision-making process guided by a healthcare professional with expertise in the field. Recent studies indicate that men under active monitoring by their doctors achieved similar survival rates as those who opted for surgical intervention or radiation therapy.

New findings presented at the European Association of Urology (EAU) Congress in Milan and published on March 11 in The New England Journal of Medicine reveal that most men with low-risk prostate cancer can safely postpone radiation or surgery without increasing their risk of cancer-related death.

The study demonstrated that men who chose active monitoring had comparable high survival rates of 97 percent after 15 years, despite a slightly higher likelihood of cancer progression or spreading, when compared to those who underwent radiation or surgery.

“It’s clear that, unlike many other cancers, a diagnosis of prostate cancer should not be a cause for panic or rushed decision making,” said lead author Freddie Hamdy, MD. He is a professor of urology and head of the Nuffield department of surgical sciences at the University of Oxford in England, in a press release.

“Patients and clinicians can and should take their time to weigh up the benefits and possible harms of different treatments, in the knowledge that this will not adversely affect their survival,” Dr. Hamdy said.

“This is a landmark study that was well designed with a large number of patients and a 15-year follow-up,” said Nitin Yerram, MD. He is co-director of urologic oncology and director of urologic research at Hackensack University Medical Center in New Jersey. “And it’s telling us that surveillance is a really great option for men with low-risk prostate cancer, [since it] resulted in the same mortality rates as surgery and radiation,” says Dr. Yerram, a doctor not involved in the study.

Treatment or Not?

According to the American Cancer Society, prostate cancer ranks as the second leading cause of cancer-related deaths among men in the United States, following lung cancer. While many cases of prostate cancer progress slowly and remain localized within the prostate gland, certain types can be aggressive and metastasize to other parts of the body, as noted by Mayo Clinic.

Dr. Shawn Dason, a urologic oncologist at The Ohio State University Comprehensive Cancer Center in Columbus, explains that there is evidence supporting active surveillance and the decision to forgo treatment for prostate cancer. Conversely, there is also evidence suggesting that certain treatments play a crucial role in prolonging survival for individuals with prostate cancer.

“This is really the challenge for clinicians in today’s world,” says Dr. Dason. He also was not involved in the study. “After assessing the risk level, we need to make sure we’re not overtreating [patients] by potentially giving them treatments that could have urinary or sexual side effects. But in many cases, we will eventually need to treat with radiation and surgery.”

Prostate Cancer Survival Rates Similar for Active Monitoring, Radiation, and Surgery

The study involved 1,643 men aged 50 to 69 from different parts of the United Kingdom who were diagnosed with localized prostate cancer between 1999 and 2009 after a PSA blood test. None of the participants had cancer that had spread to other parts of their bodies, and 77 percent of them were initially classified as low-risk.

Localized or low-risk prostate cancer, which is limited to the prostate gland, tends to grow slowly or not at all, according to

Upon enrollment, the men were randomly assigned to one of three treatment groups:

  1. Active monitoring: Regular blood tests were conducted to monitor PSA levels.
  2. Radiotherapy: Hormone-blockers and radiation were used to shrink tumors.
  3. Prostatectomy: Surgery was performed to remove the prostate.

Men in the active monitoring group had a higher likelihood of cancer progression and spreading compared to the other groups. If their cancer progressed to a point where further treatment was necessary, they could switch to a different treatment group.

Despite the fact that all groups had a 97 percent survival rate, nearly one in four men in the active monitoring group had not received any invasive treatment for their cancer even after 15 years.

It is noteworthy that the active monitoring group achieved a high survival rate, especially considering that approximately 30 percent of the men in the study were later found to have intermediate-risk prostate cancer. This information came to light when their original health data was reanalyzed using modern tests that were not available when the study commenced.

This is a seminal study in the field, Dason added, because there are not too many studies of this magnitude and this length of follow up. “These findings show that it’s likely safe to monitor these patients until their cancer progresses and then treat them at the time of progression. It really supports active surveillance for a lot of these patients,” he explained.

“Patients and doctors now have the necessary information on the long-lasting side effects of treatments to better understand the trade-offs between their benefits and harms,” spoke coauthor Jenny Donovan, PhD, professor at the University of Bristol in England, in a press release.

Since survival was very similar for all three choices, men diagnosed with localized prostate cancer can choose their own values and priorities when making deciding about which treatment to get, said Dr. Donovan.

Surveillance Even More Effective with Advancements in Imaging and Biopsies

“When somebody is diagnosed with low-risk prostate cancer and it’s decided that you don’t need to treat this right away, [doctors need to] very closely follow them to look for progression — that’s called active surveillance,” Dason said.

According to an editorial in The New England Journal of Medicine, it is important to acknowledge that active monitoring, as practiced in this trial, has significantly improved over the past 15 years. The researchers involved in the study did not have access to all the advanced tools and technologies that are available today, such as safer biopsy procedures and enhanced imaging techniques like prostate MRI, as pointed out by Dason.

In the active monitoring group, around 9 percent of men experienced metastasis of their cancer, compared to 5 percent in the other two groups. However, it is likely that these percentages would be even smaller if the currently available monitoring tools were utilized, as emphasized in the editorial.

“Nowadays, active surveillance for prostate cancer could include PSA (prostate-specific antigen) testing every six months, MRI testing every two years, repeat biopsies, maybe up front at a year after diagnosis, and then every three to five years,” said Dason.

Prostate Cancer Treatment Could Impact Urinary and Sexual Function

Patients from all three groups reported that they experienced the same general quality of life, when talking about general mental and physical health, as per findings.

Investigators also saw that the negative effects of radiation and surgery on urinary and sexual function last much longer than they assumed, and in some cases, it lasted as long as 12 years.

There’s no doubt that there are urinary and impotence issues after radiation and surgery, explained Yerram. “But as men get older, these issues can occur even without treatment for prostate cancer, and so it’s hard to tease out the effects of the treatments,” he also said.

After the study, nearly all of the men said to have experienced low sexual function, but their patterns of decline varied and depended on their treatment for prostate cancer, said Donovan.

In the End: Surveillance Is a Safer Choice for Most, but Not All, Men

Although the findings made supported the active surveillance, it’s also crucial not to group everyone with prostate cancer in the same block, Yerram said. “We need to have individual discussions to see the best treatment plan for them,” he shared.

There are also more men diagnosed with more advanced prostate cancer lately, Yerram said. “These are men with high-risk prostate cancer — prostate cancer that we’re concerned might have spread based on some of our testing. It would be a mistake to think that these results apply to this group, because that wasn’t the type of patient who was studied here,” he said.

Those patients will almost definitely reap the benefits from the treatment to improve their quality of life as well as extend their lifespan, Yerram shared.