Fifteen-year outcomes following conservative management of prostate cancer

This study investigated the long-term outcomes of conservative management of localized prostate cancer in men aged 65 and over.

Increased levels of prostate specific antigen (PSA; a protein elevated in prostate cancer) screening is allowing the detection of prostate cancer when it has not yet spread to other parts of the body. Treatment options for these men may include active surveillance or conservative management, where the cancer is monitored closely but no treatment is administered. Only a small percentage of men choose to have their cancer managed conservatively, possibly due to fear of disease progression.

The authors aimed to evaluate the 15-year outcomes of conservative management of prostate cancer. 31,137 men aged 65 and over were followed. Only patients who were not receiving radiation therapy, cryotherapy (freezing the tumor cells to kill them), surgery or androgen-deprivation therapy (therapy that targets hormones such as testosterone) at the beginning of the study were included. Up to 50% of patients subsequently underwent some form of therapy during the course of the study.

After 15 years, of the men aged 65-74 with Gleason 5-7 cancer (generally regarded as ‘low risk’ based on the appearance of the tumor cells under a microscope) 5.7% had died due to prostate cancer. Of men of the same age group with Gleason 8-10 cancer (generally regarded as ‘high risk’) 22% had died due to prostate cancer. The percentage of patients dying from prostate cancer in both cases was higher for men aged over 75; 10% for Gleason 5-7 patients and 27% for Gleason 8-10 patients.

The authors of this study suggested that conservative therapy may be beneficial for elderly men with low-grade (‘low risk’) early stage prostate cancer, while men with higher-grade cancer may want to consider more aggressive treatment.

This study only gives information about conservative management in men aged 65 and over.

If you have low-grade, early-stage prostate cancer, talk to your doctor about the benefits and drawbacks of conservative management.