Prostate cancer survival no better with surgery or radiotherapy over active surveillance

Prostate cancer survival no better with surgery or radiotherapy over active surveillance

Don’t panic and rush into treatment as the three treatment options offered on the NHS in the UK, including ‘Watch and wait’, all have similar survival rates claims Dr Freddie Hamdy In a 2023 study from Oxford University.

 

A study by the National Cancer Institute (NCI) in the USA (1) shows that since 2014, the number of men with prostate cancer who are on ‘Active Surveillance has more than doubled from 26.5% to 58.6% by 2021. The study from 240 urology centres across the country concluded that this was ‘a move in the right direction’ since most prostate cancers were small and confined to the prostate, as confirmed by PSA and Gleason testing.

Less than half of the men on ‘Active Surveillance’ or ‘watch and wait’ are treated within 5 years of starting the programme.However, rates vary widely across the country.

UK Study shows survival differences not significant

In a second study (2), which followed 1600 men in the UK and was presented at the European association of Urology Conference in Milan, March 2023, Oxford Professor Dr Freddie Hamdy showed that Active Surveillance was a safe alternative for most men. Men diagnosed with localised prostate cancer shouldn’t panic and rush into treatment options such as radiotherapy or surgery. Instead, they should “consider carefully the possible benefits and harms caused by the treatment options.”

The Study in the New England Journal of Medicine showed little difference in survival across the 15 year study period from 1999. Death from prostate cancer occurred in 3.1% of the ‘Active Surveillance’ group, 2.2% of the surgery group, and 2.9% of the radiation group. These differences are considered to be statistically insignificant.

Moreover, at the end of the 15 year study, the prostate cancer had spread in 9.4% of the AS group, 4.7% of the surgery group and 5% of the radiation group. But spread did not equate to significant survival differences. Hamdy reflected that in the 23 years since the start of the study, diagnostic tests had also improved significantly.

‘Watch and wait’ was a phrase used consistently by CANCERactive after 2002 studies of men over 50 killed in car accidents in California showed that over 60% were driving around with prostate cancer, didn’t know it and weren’t receiving treatment. It showed that, from initial diagnosis, treatment was rarely urgent.

The Stocholm-3 test for prostate cancer

All this comes as the Stocholm-3 test comes to the fore (3). It is an AI assisted model for Prostate cancer testing and is a ‘blood based diagnostic test’ to be used alongside the much-criticised PSA test. 

The technology uses an algorithm that combines 5 plasma protein biomarkers, genetic markers, and clinical data (total PSA and free PSA) and would be used in people with a PSA of over 1.5 nanograms per ml. The genetic markers include 101 single nucleotide polymorphisms. The clinical data captured in the algorithm includes age, family history and previous prostate biopsy.

It sounds like more testing but those arguing for the test say it is more accurate for predicting cancer and its aggression, and less tests and biopsies would be required. Of course, NICE likes the idea but has a problem with the cost, but then, no one said AI was cheaper (4).

Although at CANCERactive we may have used the term ‘Watch and Wait’ before many others did, we also told people with symptoms that there was a lot they could do to help themselves, rather than wait and do nothing!

Go to: 12 Natural Compounds that fight Prostate cancer
 

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References

  1. Active Surveillance for Low-Risk Prostate Cancer Continues to Rise; NCI - https://www.cancer.gov/news-events/cancer-currents-blog/2022/prostate-cancer-active-surveillance-increasing

  2. Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer; Freddie C Hamdy et al; NEJM, April 27, 2023

  3. The Stockholm-3 Model for Prostate Cancer Detection: Algorithm Update, Biomarker Contribution, and Reflex Test Potential; Peter Ström et al; Eur Urol. 2018 Aug;74(2):204-210.  

  4. Stockholm3 for prostate cancer screening; NICE 9 August 2022

 

 


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2023 Research
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