One-fourth of men drop out of prostate cancer surveillance

About one-fourth of men with slow-growing prostate cancer who undergo active surveillance drop out of the program, according to findings from a relatively small European study.

The results raise questions about the safety of active surveillance, say the study’s authors, who presented the findings at the European Association of Urology annual congress in Stockholm, Sweden.

The long-term study, conducted in an average-size, non-academic hospital, followed 157 patients over a 13-year period of surveillance. After 13 years, researchers found that 28% of all patients needed definitive treatment. Almost all of these men were cured from cancer. However, it was also found that about another one-fourth (27%) of all patients did not show up for the recommended appointments.

These men did not reply to follow-up letters requesting ongoing check-up, thus dropping out of the active surveillance system.

“The limitation of this study is that this is not a huge sample, but nevertheless it is one of the best ‘real-world’ samples we have with long-term data,” said lead researcher Lukas Hefermehl, MD, of Kantonsspital Baden in Baden, Switzerland. “I strongly believe that active surveillance is a good option for men who follow the recommended controls. But from our results it looks like there must be a significant number of men lost to follow-up who will eventually develop a progressive disease; many of these men may even eventually die of prostate cancer.”

The group also found that just 3 months after the initial diagnosis, 30 men (19%) refused a mandatory confirmation biopsy, which could have ruled out an incorrect interpretation of the first biopsy.

“We don’t know exactly what the reasons are,” Dr Hefermehl said. “It may be that once the patient was told that this cancer is probably ‘not immediately threatening,’ he might downplay the importance of another test. On the other hand, some men might have real concerns about the risk of there being a more severe cancer. Or it may be to do with the risk of incontinence or impotence after treatment, the idea of having cancer, a sense that nothing will really happen to them, or it may be due to another reason which we just don’t know about.”

Look for additional coverage of the EAU annual congress in upcoming issues of Urology Times.

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