Monitoring Lacking in Prostate Cancer Patients Choosing Surveillance

Men diagnosed with prostate cancer who opt for active surveillance/watchful waiting rather than active treatment may not be receiving quality monitoring of their disease. These men are less likely to receive prostate-specific antigen (PSA) testing and to be evaluated by a clinician within 2 years of their diagnosis compared with men undergoing treatment of their cancer (P < .01). These results are published in the journal Cancer.

Karim Chamie, MD, of the UCLA Jonsson Comprehensive Cancer Center, and colleagues analyzed Surveillance, Epidemiology, and End Results (SEER)–Medicare data of 37,867 men diagnosed with prostate cancer between 2004 and 2007 who were followed through 2009.

The study, according to the authors, is among the first population-based studies to understand the quality of surveillance for prostate cancer in the United States.

Only 4.5% (166 of 3,656) of the prostate cancer patients who chose active surveillance/watchful waiting were actually being regularly evaluated by their clinician, according to the results of the study.

While most men who opted for surveillance did not receive the recommended, regular follow-up of at least four PSA tests, four office visits, and at least one repeat biopsy within 2 years, the number of men who received appropriate care did increase between 2008 and 2009 (P < .01).

Only 13% of men in the active surveillance/watchful waiting group had a second biopsy within 2 years of their cancer diagnosis.

Men 80 years and older (P < .01) and those with a Charlson score of 1 (P = .04) were less likely to undergo surveillance. Gleason score was not a predictor of whether a man with prostate cancer received appropriate active surveillance.

Active surveillance is recommended for men with low-risk disease over aggressive treatment, as surgery and radiation therapy can result in erectile and urinary dysfunction without improving cancer outcomes. Current recommendations of active surveillance are regular PSA testing, clinical follow-up visits for physical examination, and at least one additional prostate biopsy within 2 years of diagnosis.

“Many researchers have been advocating for active surveillance for men with low-risk disease,” said Chamie in a statement. “However, this study suggests that before we advise our patients to pursue active surveillance for their prostate cancers, we should be certain that we are committed to closely monitoring the cancers with a repeat biopsy, PSA testing, and physical exams.”

Sixty percent of patients included in the analysis were between the ages of 65 and 74, 55% had T1 tumors, and 43.9% had a Gleason score of 6 or less.

The authors noted that some of the study limitations included the inability to discern between active surveillance and watchful waiting, and that the data were limited to men aged 65 years or older. Whether the same surveillance patterns are also seen among younger men is unclear.

The study authors are currently following the patient data to understand how surveillance will change with longer time from the initial diagnosis.