Risk-oriented Healthcare Increases for Patients With Prostate Cancer

Matthew Cooperberg, MD, MPH

Matthew Cooperberg, MD, MPH

Patients with prostate cancer are now more likely to receive appropriate medical care matched to their level of risk, as opposed to overly aggressive or inadequate treatments, according to a study¹conducted at University of California, San Francisco.

Peter Carroll, MD, MPH and Matthew Cooperberg, MD, MPH of the UCSF Helen Diller Family Comprehensive Cancer Center analyzed the data of about 10,500 patients with tumors classified as stage cT3aNOMO or lower managed with prostatectomy, radiation, ADT monotherapy, or AS, from 45 urology practices across the United States collected in UCSF’s CaPSURE registry.¹

Between the years of 1990 and 1994, 9.7% of intermediate-risk disease patients with prostate cancer were treated with androgen-deprivation therapy (ADT) as opposed to 3.8% between the years of 2010 and 2013. Thirty percent of patients with high-risk disease received ADT within the years of 1990 and 1994 and 24% between 2010 and 2013. In the latter years of the study, 40% of men with low-risk prostate cancer chose active surveillance (AS).¹

In patients 75 years or older, the rate of AS had risen from 22% between the years of 2000 and 2004 to 76% between the years of 2010 and 2013, while the incidence of surgery stagnated within the high-risk group. In the years prior to 2010, less than 10% of patients with low-risk disease chose AS.¹

Cooperberg stated in a UCSF press release,²that he and Carroll expected to see a rise in surveillance rates, but they were surprised by the major shift toward appropriate, risk-adapted management of the disease. He explained how AS has become more broadly endorsed within recent years. Fortunately, the findings showed more aggressive management of higher-risk disease, which has the potential for improved outcomes.

“Drs. Cooperberg and Carroll are champions of the proper use of AS in men with low-risk prostate cancer. Their efforts are paying dividends in that the number of men being observed has risen from 5% to now near 40%,” said E. David Crawford, MD, professor of surgery, urology, and radiation oncology, E. David Crawford Endowed Chair in urologic oncology, and head of urologic oncology at the University of Colorado, Denver, in an interview withTargeted Oncology. While this is positive news, Crawford explained that challenges still exist. Close to 30% of men on AS will seek therapy within 5 years and 50% within 10 years.

“AS is not always a cost-savings program, and some men may choose it who are not candidates. Fortunately, in the past 2 years we have two new genomic assays, Prolaris and Oncotype DX, which help to classify men who are good candidates for AS,” Crawford continued.

The study authors hope results will also create renewed discussion for PSA screening, according to the press release.²This type of testing has created controversy in the past because of its tendency to lead to unnecessary treatment in men who have low-risk disease. Carroll expressed concern regarding the lack of support for PSA testing from many primary care physicians. Potentially lethal, high-risk tumors that need quick attention may go unnoticed and the study authors hope to see a smarter screening and treatment paradigm in the future.²

Crawford agreed with Carroll and Cooperberg that many family practice physicians choose not to order PSA testing, which could lead to the inability to treat and cure countless men who would benefit from treatment. Crawford congratulated the authors who have now effectively directed more men toward AS.

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References:

1. Cooperberg MR, MD, MPH, Carroll PR, MD, MPH. Trends in management for patients with localized prostate cancer, 1990-2013.JAMA. 2015;314(1):80-82. doi:10.1001/jama.2015.6036.

2. University of California, San Francisco. For prostate cancer patients, risk-specific therapies now more the norm.http://www.ucsf.edu/news/2015/07/131061/prostate-cancer-patients-risk-specific-therapies-now-more-norm. Accessed on July 27, 2015.