Treatment or Active Surveillance for Early-Stage Prostate Cancer?

Prostate cancer is the most common cancer in men in Turkey after lung cancer, but when detected at an early stage, 5-year survival exceeds 90%. Of course, as with every cancer type, prostate cancer treatment varies by stage. For example, early-stage prostate cancer has several treatment alternatives, such as surgical removal of cancerous tissue, radiotherapy, or active surveillance (close monitoring) without an urgent intervention. However, the shock and stress experienced after diagnosis make it difficult for patients to ask their doctors everything. At this point, it is extremely important for doctors to inform and guide patients.

The ideal treatment for early-stage prostate cancer remains the subject of many ongoing studies. Some earlier studies reported fewer prostate cancer deaths and longer survival in patients who underwent surgery for early-stage prostate cancer. However, current studies suggest that active surveillance also produces good outcomes in early-stage prostate cancer that has not spread beyond the prostate. Prostate cancer is sensitive to male hormones, and some prostate cancers may therefore grow and spread very slowly. Whether the cancer has aggressive biology, meaning its risk category, has become important in this context.

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Compared with observation, treatment in men with early-stage cancer, particularly those with intermediate- or high-risk disease, reduces the risk of overall and prostate cancer-specific death.

Low-risk disease should preferably be managed with active surveillance in men who have it.

Questions About Early-Stage Disease

Data on survival following initial risk-based treatment for early-stage prostate cancer are limited.

The initial treatment strategy for intermediate- and high-risk disease is controversial.

Demonstrating a survival advantage with active treatment in patients with intermediate- and high-risk disease may help clarify the preferred approach.

A New Study

Early-stage T1c-2cN0M0 prostate cancer cases were analyzed using 2010-2016 SEER (Surveillance, Epidemiology, and End Results) data, which can be described as US cancer statistics. Outcomes in approximately 500 thousand cases were analyzed.

Note: The T stage provides an indication of the tumor's size and local extent. For prostate cancer, T1 and T2 mean that the tumor is within the prostate. T3 and higher indicate that the tumor has extended beyond the prostate capsule and spread to the surrounding area.

Most patients included in the study belonged to the intermediate- and high-risk groups.

The researchers compared outcomes with observation, radiotherapy and radical prostatectomy.

Participants had PSA (prostate-specific antigen) levels of 50 ng/mL or less and were aged 50-79 years.

The median follow-up was 36.5 months.

Notable Results

• Observation had the lowest 5-year overall survival rate (91.6%), followed by radiotherapy (92.4%) and radical prostatectomy (96.1%; P < 0.001).
• Compared with observation, radiotherapy improved prostate cancer-specific survival only in the high-risk group, while radical prostatectomy significantly improved prostate cancer-specific survival in both intermediate-risk (hazard ratio [HR], 0.43) and high-risk men (HR, 0.36) (for both P < 0.001).
• However, the treatments did not provide a prostate cancer-specific survival benefit in low-risk disease.

In conclusion, this study once again demonstrated the importance of risk classification in early-stage prostate cancer. Active surveillance without treatment appears to be the ideal option in early-stage, low-risk prostate cancer, referring to a tumor confined to only one half of the prostate gland, a PSA below 10 and a Gleason score below 7.