The results of a recent prostate cancer study have begun hitting the public domain, once again creating questions and potential confusion for patients and their loved ones about whether or not to opt for treatment after a prostate cancer diagnosis.
This 20-year study, titled “Prostate Cancer Intervention Versus Observation Trial” (PIVOT) concluded that treating prostate cancer in men with early-stage disease with either surgery or radiation offers negligible benefits. While this seems like a simple and straightforward finding on its surface, the concept of prostate cancer risk typing must be factored into the equation.
[See: 10 Questions to Ask Your Doctor About Prostate Cancer.]
First, please note that the PIVOT study confirms what some doctors follow in their practice. Men with early-stage prostate cancer can be subdivided into three risk groups: low, intermediate and high. Low-risk patients have PSA levels of less than 10 and a Gleason Score of 6 or less. Intermediate-risk patients have PSA levels between 10 to 20 and/or a Gleason Score of 7. High-risk patients have PSA levels greater than 20 and/or a Gleason Score of 8 or higher. Low-risk patients may safely undergo surveillance without treatment. Intermediate-risk patients will benefit and should undergo treatment. Some high-risk patients will also benefit from treatment.
It is well known that men belonging to the low-risk category may be safely placed on active surveillance without the need for immediate treatment. In this risk category, it is not necessary to provide treatment. However, one possible pitfall to emerge from the PIVOT study is the thinking that low-risk patients do not need follow up and will never require treatment.
Some doctors don’t practice — nor do they recommend — completely forgetting about or ceasing to follow patients in this category. Patients belonging to the low-risk prostate cancer category can be reassured that they most likely will never need treatment. With that said, those doctors take great care in not leading them into a false sense of security. Some men belonging to this risk category will eventually develop more aggressive prostate cancer that will require treatment. Therefore, patients with diagnoses in the low-risk category should be followed with PSA testing and imaging, and they should possibly repeat prostate biopsy.
[See: Which Medical Screenings Should You Have in 2017?]
Men in the intermittent-risk category have a high chance of progression of their prostate cancer and death as a result. These men will benefit from treatment, usually surgery or radiation. Most men in the intermediate-risk category who undergo treatment will have an excellent chance at curing the cancer and a high survival rate, in addition to a reduced risk of developing health problems from advanced prostate cancer. These patients should be counseled against active surveillance, unless they have a short life expectancy (less than 10 years).
Men in the high-risk prostate cancer group have a higher chance of death and health problems whether they do or don’t undergo treatment. However, men in the high-risk category will have a higher chance of survival if they undergo multimodality treatment. For a man belonging to the high-risk group to have a fighting chance against his prostate cancer, a combination of hormone therapy, surgery and radiation is recommended. In this risk category, radiation alone or surgery alone may not be enough. These patients are indeed the most vulnerable and will require very close follow-up.
[See: How to Be a Good Patient Wingman.]
While the PIVOT study helps health care professionals continue to hone treatment recommendations for the greatest good of men diagnosed with prostate cancer, it is important to recognize that cancer, no matter the type, is not a one-size-fits-all proposition. General guidelines are important, of course, but a personalized plan based on a number of unique factors is the best prescription for our patients.
More from U.S. News
10 Things Younger Men Should Know About Prostate Cancer
10 Questions to Ask Your Doctor About Prostate Cancer
Which Medical Screenings Should You Have in 2017?
Low-Risk Prostate Cancer Is Not No-Risk Prostate Cancer originally appeared on usnews.com
