Surveillance rarely used in stage 1, 2 prostate Ca

While close to 90% of men diagnosed with prostate cancer between 1998 and 2012 had stage 1 and stage 2 disease, more than 90% underwent surgery or radiation to treat the cancer, according to a study presented at the Genitourinary Cancers Symposium in Orlando, FL.

Researchers analyzed the National Cancer Database from 1998 to 2012. Treatment status information was available for 337,658 of the 1,803,596 men diagnosed with prostate cancer during those years.

They found that nearly 4% were under active surveillance, which is deferred treatment until it’s absolutely necessary, and 4% received no treatment or surveillance. Among the patients with stage 1 disease, 7.5% were followed with active surveillance and 2.22% of those with stage 2 prostate cancer had surveillance.

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Nearly 63% had surgery to treat the cancer and 35% received radiation.

Academic research programs were more likely than other types of centers to have patients undergoing active surveillance, taking the approach with 5.7%, or 7,524 men, during the years of the study.

The researchers’ aim, according to lead author Jeanny B. Aragon-Ching, MD, was to determine whether the advent of active surveillance screening recommendation guidelines in Canada and the U.S. have changed day-to-day practice patterns.

“Active surveillance was one of the biggest themes in the recent ASCO GU program,” said Dr. Aragon-Ching, clinical program director of genitourinary cancers at the Inova Schar Cancer Institute and associate professor of medicine, Virginia Commonwealth University in Fairfax.

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Further analysis revealed that among the men who underwent radiation, close to one-third had stage 1 disease and more than 60% had stage 2 disease. Of the men who had surgical treatment for their prostate cancer, 40% had stage 1 and 56% had stage 2 disease.

It’s hard to say whether the numbers of men undergoing active surveillance increased from the late 1990s to 2012 because of the low percentage of men, overall, in the category, Dr. Aragon-Ching said.

“One of the limitations in our undertaking is that it is a retrospective review of a big database, but it’s limited in time frame from 1996 to 2012. The practice patterns had not, perhaps, caught up with the changing times and evolutions of the guidelines,” Dr. Aragon-Ching said.

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The authors do not yet have more updated information about practice patterns but have requested to study the National Cancer Database’s most recent dataset, which goes to 2014. It wasn’t until 2016, however, that the American Society of Clinical Oncology endorsed the Cancer Care Ontario guideline on active surveillance for prostate cancer. So it could be that changes in practice are just beginning to occur, she said.

“I think active surveillance is a safe approach to the treatment of prostate cancer. Certainly not all men who are eligible to receive it are getting it. But I think there is certainly value and merit in trying to assess each and every patient for whenever active treatment versus surveillance is appropriate,” Dr. Aragon-Ching said. “I think we can work together as a group in the prostate cancer community to help achieve this. Certainly, there is a lot of interest now.”

Dr. Aragon-Ching is a consultant/adviser for Algeta/Bayer, AstraZeneca, and Dendreon; a member of the speakers’ bureau for Astellas Pharma, Bristol-Myers Squibb, and Janssen-Ortho; and has received travel, accomodations, and expenses from Algeta/Bayer and Dendreon.