Do Advanced Technologies Reduce Mortality Risk in Prostate Cancer?

Research results published by JAMA emphasized that the use of advanced technological treatments preferred by patients with prostate cancer is increasing every day and that this situation needs to be questioned.

Prostate cancer ranks fifth among the most common cancers worldwide, while in our country it ranks second among men, after lung cancer.

Developments in the scientific world lead advances in technology, and the technologies used in treatment continue to progress in parallel. Advanced technologies used to treat prostate cancer, such as intensity-modulated radiotherapy (IMRT) and robotic prostatectomy, have become preferred options among men with early-stage prostate cancer. Nevertheless, research results published by JAMA suggest that at least some patients with prostate cancer may not benefit from these treatments.

Prostate cancer is a disease seen in men that develops with aging. It can occur in many older men and may remain hidden for years without causing any symptoms. In addition, approximately %20 of men develop prostate cancer at older ages, and only %3 of this proportion face a risk of death from prostate cancer.

The treatment of early-stage prostate cancer remains open to debate because there has not yet been sufficient evidence that aggressive treatment prolongs survival. Furthermore, treatments can cause long-term side effects such as urinary incontinence and impotence. Thoughtful male patients who choose more traditional methods such as active surveillance or close monitoring are reluctant to undergo aggressive treatment until symptoms appear and/or the disease progresses. Such conservative approaches prevent patients from being exposed to unnecessary treatment and prolonged side effects.

As treatment technologies advance, more patients with prostate cancer want to benefit from them. Researchers conducted a retrospective cohort study to observe men with prostate cancer who had a low risk of death and to compare and evaluate the use of previously established standard treatments (external radiotherapy and open radical prostatectomy) with advanced treatment technologies (IMRT and robotic prostatectomy).

Data obtained from an American health insurance database were examined for men diagnosed with prostate cancer between 2004 and 2009: 23,633 who received IMRT, 3,926 who received external radiotherapy, 5,881 who underwent robotic prostatectomy, 6,123 who underwent open radical prostatectomy, and 16,384 who were only monitored. The findings were shared with the public. Follow-up ended in December 2010, and low-risk prostate cancer was defined as clinical stage T2a, a biopsy Gleason score of 6, and a prostate-specific antigen level of 10ng/mL. Among patients with low-risk cancer, advanced treatment technology use was recorded in 2004 at %32 and increased in 2009 to %44. Moreover, among men with a high risk of death unrelated to cancer, preference for advanced treatment technology was recorded in 2004 at %36 and increased in 2009 to %57. Among men with low-risk cancer and a high risk of noncancer death, the rate was recorded in 2004 at %25 and rose in 2009 to %34. Among men without a risk of death from prostate cancer, advanced treatment technology use was recorded in 2004 at %13 and increased in 2009 to %24. Overall, the trend toward advanced technologies was found to have increased by %85 in recent years. During the same period, use of methods known as standard treatments in this group fell from %11 to %3. Apparently, IMRT replaced conventional external radiotherapy and robotic prostatectomy replaced open radical prostatectomy, regardless of whether there was a benefit.

Researchers concluded that the use of advanced treatment technologies increased among men with low-risk prostate cancer diagnosed between 2004-2009. The next step in this research will be to better understand which patients with prostate cancer will benefit from treatment. A second step should examine the biological aggressiveness of the disease in each patient to distinguish those who require treatment.

New technologies always excite us and help us look to the future with greater hope. However, selecting the right patients for these technologies and allowing scientific evidence that will facilitate this selection to mature are extremely important.