Observation safe, cost effective for low-risk prostate cancer

June 24, 2013

Observation appears to be safe and more cost effective than immediate treatment for many men with low-risk, localized prostate cancer, according to a recent study from Dana-Farber Cancer Institute and Massachusetts General Hospital, Boston.

Observation appears to be safe and more cost effective than immediate treatment for many men with low-risk, localized prostate cancer, according to a recent study from Dana-Farber Cancer Institute and Massachusetts General Hospital, Boston.

First author Julia Hayes, MD, and colleagues created mathematical models to construct a variety of scenarios, focusing on men ages 65 or 75 years of age at diagnosis and including estimated costs associated with treatment and different forms of observation.

In active surveillance, patients underwent PSA screening every 3 months, rectal examinations every 6 months, and a prostate biopsy at 1 year and then every 3 years. Patients who chose watchful waiting were observed without intensive monitoring and given palliative treatment if the cancer became symptomatic.

The authors calculated the quality-adjusted life expectancy (QALE). They also estimated the lifetime costs of each strategy, which ranged from $18,302 for watchful waiting for men aged 75 years to $48,699 for a 65-year-old patient treated with intensity-modulated radiation therapy.

The bottom-line result was that observation was more effective and in some cases less costly than initial treatment for low-risk prostate cancers. Watchful waiting yielded 11 months additional QALE over brachytherapy-the most effective treatment-and 13 months additional QALE over radical prostatectomy, the least effective treatment.

Dr. Hayes acknowledged that the study made assumptions based on limited research data on these issues. Nevertheless, “It appears that active surveillance and watchful waiting are safe alternatives to initial treatment for prostate cancer based on these assumptions,” she said. “But it’s important to emphasize that these decisions are very much a matter of individual choice.”

“A previous study by Dr. Hayes and colleagues demonstrated that active surveillance is a reasonable option for men with low-risk disease and associated with a better quality of life,” commented co-author Philip Kantoff, MD. “As non-treatment becomes a more accepted option for these patients, selecting those who require less aggressive assessment including biopsy will become important.”

Results of the study were published in Annals of Internal Medicine (2013; 158:853-60).

 

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