Observation is safe, cost-saving in low-risk prostate cancer

Study suggests low-risk patients can forego immediate treatment

Many men with low-risk, localized prostate cancers can safely choose active surveillance or “watchful waiting” instead of undergoing immediate treatment and have better quality of life while reducing health care costs, according to a study by researchers at Dana-Farber Cancer Institute and Massachusetts General Hospital.

Writing in the June 18 issue of the Annals of Internal Medicine, the authors said their statistical models showed that “observation is a reasonable and, in some situations, cost-saving alternative to initial treatment” for the estimated 70 percent of men whose cancer is classified as low-risk at diagnosis.

The researchers, led by Julia Hayes, MD, a medical oncologist in the Lank Center for Genitourinary Oncology at Dana-Farber, said their findings support observation - active surveillance and watchful waiting - as a reasonable and underused option for men with low-risk disease.

“About 70 percent of men in this country have low-risk prostate cancer, and it’s estimated that 60 percent of them are treated unnecessarily” with various forms of radiation or having the disease removed with radical prostatectomy surgery, said Hayes, who is also a senior scientist at MGH’s Institute for Technology Assessment. A clinical trial called PIVOT reported that such men had about the same small risk of death over a 12-year period whether they underwent radical prostatectomy or simply observation.

Hayes and her co-authors created mathematical models to construct a variety of scenarios, focusing on men ages 65 or 75 at diagnosis, and including estimated costs associated with treatment and different forms of observation.