Interpreting the study on early prostate cancer survival with Urologist and prostate cancer expert, Dr. Fred Saad
Toronto, ON – September 19, 2016: A study published last week
in the New England Journal of Medicine followed men with localized (contained to the prostate) prostate cancer for 10 years as they underwent one of three randomized treatment streams has since been widely reported on. Notably, many of the headlines touched upon the same reassuring conclusion: whether participants were treated with radiation therapy, had their prostates removed altogether, or were simply monitored using Prostate-Specific Antigen (PSA) tests, survival after ten years was the same at 99 per cent.
In the following days, many nuanced interpretations have been made regarding the threat that prostate cancer actually poses and the value of screening and treatment. We asked Urologist and prostate cancer expert, Dr. Fred Saad of l’Université de Montréal to weigh in and help clarify the study’s findings.
1. What was the most important finding from the study for you and why?
The most important finding from this long awaited study confirms several things that are very important. First, that patients diagnosed early with prostate cancer have long survivals and over 90% of patients will not die of prostate cancer at 10 years. However, patients who are treated early rather than followed are at significantly reduced risk of disease progression and developing metastases. This allows patients to avoid additional treatment that is both costly and with side-effects. The most intriguing aspect of the study is the fact that 77% of patients actually had what we consider low-risk cancers. One may speculate that differences in outcome would have been even more dramatic had there been more patients with intermediate- or high-risk cancers.
2. What are the strengths and weaknesses of the study?
The most obvious strength is the fact that patients were randomized into 1 of the 3 approaches to newly diagnosed prostate cancer: Observation, surgery and radiation therapy. This is the best method to objectively evaluate the advantages and risks of each option. This is truly the first large and well conducted study that was able to effectively randomize patients.
3. How do the results from this study affect how you advise and manage your prostate cancer patients?
This confirms that patients need to be informed of their options, and that 1 size does not fit all. The pros and cons of each option need to be considered when deciding which option fits best in terms of patient priorities. It also clearly demonstrates that detecting and treating the disease early delays or prevents the risk of developing incurable metastatic prostate cancer. Obviously deciding whether to treat or not continues to be based on the agressivity of the cancer at the time of diagnosis as well as patient age and life expectancy. This is especially important when one considers that at 10 years there was no difference in the risk of dying from prostate cancer when diagnosed early.
Based on Dr. Saad’s responses, we can take away this very important message: while there is no one-size-fits-all solution to prostate cancer, and there are pros and cons to each decision, patients need to be informed of their options when deciding which option fits best in terms of patient priorities. In Canada, the majority of patients with low-risk cancers are managed with active surveillance and will get treatment only if there is evidence that the cancer is progressing. However, knowing whether a patient has low-risk prostate cancer or a more aggressive form that may be lethal requires that men be tested. More than anything else, this study has reinforced the fact that time is our greatest ally when faced with prostate cancer. With more time, we have more choice. Early detection truly is key.
to learn more about the study.
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