Active surveillance for low-risk prostate Ca may offer better QoL

Among low-risk prostate cancer patients, active surveillance shows higher measures on quality of life than an initial treatment such as surgery, although the optimal strategy appears highly dependent on individual patient preferences, according to a study published in JAMA (2010; 304:2373-80).

First author Julia H. Hayes, MD, of the Dana-Farber Cancer Institute, Boston, and colleagues examined the quality of life benefits and risks of active surveillance compared with initial treatment for men with low-risk, clinically localized prostate cancer. In the study, which used a simulation model, men were treated at diagnosis with brachytherapy, intensity-modulated radiation therapy (IMRT), radical prostatectomy, or followed up by active surveillance. Probabilities were derived from previous studies and literature review.

The researchers found that in men 65 years of age, active surveillance, with IMRT for progression, was the most effective strategy.

“Brachytherapy and IMRT were less effective at 10.57 and 10.51 quality-adjusted life-years [QALYs], respectively,” the authors wrote. “Radical prostatectomy was the least effective treatment, yielding 10.23 QALYs. The difference between the most and least effective initial treatment was 0.34 QALYs, or 4.1 months of quality-adjusted life expectancy [QALE].

“In contrast, active surveillance provided 6.0 additional months of QALE compared with brachytherapy, the most effective initial treatment.”

The researchers also conducted an analysis to identify how much greater the risk of prostate cancer-specific death would have to be under active surveillance compared with initial treatment for the two approaches to be associated with equal QALE.

“For QALE to be equal, 15% of men undergoing active surveillance would have to die of prostate cancer, as opposed to 9% who received initial treatment, a lifetime relative risk of death of 0.6 for initial treatment versus surveillance,” the authors wrote.