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Dr. Patrick Nesbitt M.D. Family Physician, Vancouver B.C. ..................................Medicine and Fun .........drpat@ live . ca ................NOW BOOKING PATIENTS AT CAULFEILD 604 922 1544

​Monitoring of Early Prostate Cancer Tied to Higher Risk for Metastases

Active monitoring of early prostate cancer is associated with higher rates of metastases and disease progression relative to radical treatments, but 10-year mortality rates are similar, according to a New Engla
Active monitoring of early prostate cancer is associated with higher rates of metastases and disease progression relative to radical treatments, but 10-year mortality rates are similar, according to a New England Journal of Medicine study.

Roughly 1600 men aged 50–69 who were diagnosed with localized prostate cancer were randomized to active monitoring, radical prostatectomy, or radiotherapy. After a median 10 years’ follow-up, prostate-cancer survival was around 99% in all three groups. Active monitoring, compared with surgery or radiotherapy, was associated with higher rates of disease progression (23 vs. 9 per 1000 person-years) and metastatic disease (6 vs. 2–3 per 1000).

An editorialist writes: “If a man wishes to avoid metastatic prostate cancer ... monitoring should be considered only if he has life-shortening coexisting disease such that his life expectancy is less than the 10-year median follow-up of the current study.”

In a companion NEJM study, the active monitoring group initially had better urinary and sexual function than did the radical treatment groups, but these measures got worse with time due to age-related changes and more men choosing radical treatments.

Why We Chose This as Our Top Story:


William E. Chavey, MD, MS: This is particularly relevant for primary care because we may be discussing, in a shared medical-decision-making model, issues related to this balance of quality-of-life versus metastatic disease.
nd Journal of Medicine study.
Active monitoring of early prostate cancer is associated with higher rates of metastases and disease progression relative to radical treatments, but 10-year mortality rates are similar, according to a New England Journal of Medicine study.

Roughly 1600 men aged 50–69 who were diagnosed with localized prostate cancer were randomized to active monitoring, radical prostatectomy, or radiotherapy. After a median 10 years’ follow-up, prostate-cancer survival was around 99% in all three groups. Active monitoring, compared with surgery or radiotherapy, was associated with higher rates of disease progression (23 vs. 9 per 1000 person-years) and metastatic disease (6 vs. 2–3 per 1000).

An editorialist writes: “If a man wishes to avoid metastatic prostate cancer ... monitoring should be considered only if he has life-shortening coexisting disease such that his life expectancy is less than the 10-year median follow-up of the current study.”

In a companion NEJM study, the active monitoring group initially had better urinary and sexual function than did the radical treatment groups, but these measures got worse with time due to age-related changes and more men choosing radical treatments.




​Dr. Patrick  Nesbitt, Vancouver, Canada ....www.drpat.ca ........ drpat@live.ca