A long-term study from Great Britain shows the effects of radiation and surgery on prostate cancer.
London – The risk of developing prostate cancer is comparatively high in men over the age of 50.
About 70,000 men are diagnosed with prostate cancer each year - it is the most common type of cancer in men.
In the UK Protect study, professionals looked at low-risk cancers and their evolution according to the type of treatment: surgery, radiation and surveillance.
The first results of the study were published in 2016.
15 years after the therapy decision, long-term data on survival rates and side effects have now also been disclosed.
The results show that radiation and surgery is not always the best option.
Long-term study: Same mortality rate when observing prostate cancer
The long-term results of the Protect study show that patients with low-risk cancer have the same disease-specific mortality - regardless of whether they were irradiated, operated on or only actively monitored.
In active surveillance cases, patients were treated only as the disease progressed.
These results are significant for prostate cancer therapy, explains Professor Peter Albers, Director of the Clinic for Urology at the University Hospital Düsseldorf in an interview with the
FAZ
.
"In the Protect study, a PSA value was determined only once a year, and a diagnosis was only triggered when this value had risen by 50 percent." Accordingly, a harmless type of monitoring is already sufficient to ensure the survival of the patients.
Prostate cancer study: Monitoring should prevent the formation of metastases
According to research, every tenth patient who was actively monitored developed metastases.
Bone and lymph node metastases, which can be easily treated today, were often involved.
However, these are an indicator of the progression of the disease and must be treated accordingly.
“It has a major impact on the quality of life.
In the future, we must therefore use active surveillance to prevent metastases from developing,” says Alberts.
The study results show that only 45 of the 1643 participants died from the cancer in the 15 years after diagnosis.
Alberts assumes that the disease-specific mortality could be due to a "lethal cancer" phenotype.
"That means that in the large group of low-risk cancers, there is a small group - that's about ten to fifteen percent - that have gene changes that lead to death."
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According to the study, low-risk carcinomas do not necessarily have to be irradiated or operated on.
© picture alliance/dpa |
Uwe Anspach
Prostate cancer: Radiation and surgery not necessary for low-risk patients
The Protect study shows that radiation and surgery are not always the first option.
Better diagnostics and active monitoring, which can detect a growing tumor faster than in the study, offer new therapeutic approaches.
"We have seen from the results of the Protect study that we can treat the low-risk cancers much more conservatively, not only the ISUP grade group 1 cancers, but also the ISUP grade group 2 cancers who have been operated on or irradiated to date," says Alberts, explaining the study results.
Cancer study: "Higher-grade carcinomas must be treated immediately and radically"
The side effects of the treatment methods have also been studied over the long term.
In some cases, impotence and incontinence were still present after twelve years.
A paper published in the journal
Jama Oncology
also indicates that many men regret their radical surgery.
The team from the USA and Canada interviewed 2000 patients with different therapy approaches after the cancer.
Accordingly, 16 percent of patients regretted the prostatectomy, i.e. the removal of the prostate.
Eleven percent who had received radiation therapy would have decided differently afterwards.
The cancer patients who only allowed themselves to be monitored were the most satisfied - only seven percent were unsure whether it was the right decision.
“We have to discuss the long-term results of the individual side effects and their influence on the quality of life very carefully with the patients.
This lengthy consultation is not paid for in Germany,” explains Alberts and demands appropriate payment for detailed consultations.
However, this counts "only for prostate carcinomas with a low risk, i.e. for carcinomas classified ISUP Grade Group 1 and 2. Higher grade carcinomas must be treated immediately and radically."
(hk)
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Uwe Anspach
