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A new study suggests that a large number of men diagnosed with prostate cancer can delay or avoid harsh treatments without lowering their chances of survival. Results from the study were presented at the 2023 Annual European Association of Urology Congress in Milan, Italy.

In 1999, researchers in the United Kingdom began to study more than 1,600 men with localized prostate cancer. They were split into three groups each using a different treatment method: surgery, radiation and active surveillance.

After 15 years, 45 had died from prostate cancer. Among that group, 12 had surgery, 16 underwent radiation and 17 were actively monitoring their cancer.

According to Dr. Julio Pow-Sang, chair of the Genitourinary Oncology Program at Moffitt Cancer Center, active surveillance typically includes a series of regularly scheduled prostate-specific antigen (PSA) tests every six months, an MRI every year and a biopsy every two to three years.

Dr. Julio Pow-Sang, Genitourinary Oncology Program

In the U.S., about 60% of low-risk patients undergo active surveillance. That number is closer to 90% in some European countries, according to Pow-Sang.

“Surgery and radiation options should be discussed,” Pow-Sang said. “But as long as the tumor remains quiet, the recommendation is to just keep an eye on it. There’s a large number of men who could benefit from this.”

Men in the study who participated in active surveillance also reduced their risk of complications including incontinence and erectile dysfunction that can follow other types of treatment.

“The patient has to be informed,” Pow-Sang said. “The most important part of active surveillance is following up with your doctor. It is only effective if the patient actually shows up.”

After 15 years, cancer had spread in 9.4% of the active surveillance group, 4.7% of the surgery group and 5% of the radiation group.

“It may sound odd to tell someone we’re not going to treat their cancer,” Pow-Sang said. “It’s up to us as physicians to explain the risks and benefits and help them understand their decisions. In my experience, 99% of patients understand active surveillance and are happy with their decision.”

The study does not apply to men who have prostate cancers that are considered high risk and high grade. These aggressive cancers account for about 15% of all prostate cancer diagnoses and would need to be treated.