MRI should play a larger role in helping docs recommend prostate cancer surveillance

With 241,740 new cases of prostate cancer expected to be diagnosed in 2012, it is, by far, the most commonly diagnosed cancer among men.

And while there are various forms of standard treatments--such as surgery, radiation therapy and chemotherapy--an increasing number of patients and their physicians are adopting the concept of active surveillance as a viable alternative for men with low-risk prostate cancer.

But, apparently not all physicians are convinced. A just-released Mayo Clinic report suggests there is some resistance to the strategy. The study of 643 urologists and radiation oncologists found that just 21 percent recommended active surveillance for managing low-risk prostate cancer, while 47 percent recommended surgery and 32 percent recommended radiation therapy.

Still, the National Comprehensive Cancer Network has recommended active surveillance as sole initial therapy for patients with low-risk prostate cancer and a life expectancy of at least 10 years or with very low-risk disease and life expectancy of 20 years.

Support for active surveillance comes from a study in the July 19 issue of the New England Journal of Medicine that found that among men with localized prostate cancer detected during the early era of PSA testing, radical prostatectomy didn't significantly reduce mortality compared to observation.

Further support comes from another study, published online Sept. 24 in Clinical Cancer Research, in which researchers developed a model that predicts men actively treated for prostate cancer won't live appreciably longer than men who adopt active surveillance. The model projected that 2.8 percent of men on active surveillance and 1.6 percent of men with immediate radical prostatectomy would die of the disease within 20 years, while immediate radical prostatectomy would increase life expectancy by 1.8 months.

FierceMedicalImaging recently reported on a study in the Journal of Urology that illustrates how imaging--specifically MRI--will play a part in this debate. In that study, researchers determined that MRI evaluation of men with low-risk cancer was highly accurate in determining whether they were good candidates for active surveillance.

"The success of active surveillance as a management strategy for prostate cancer relies primarily on the accurate identification of patients with low-risk disease unlikely to progress," the authors said. "The fact that clear tumor visualization on MRI was predictive of upgrading on confirmatory prostate biopsy suggests that prostate MRI may contribute to the complex process of assessing patient eligibility for active surveillance."

Considering the potential consequences of active treatment--such as sexual dysfunction and urinary incontinence--and the profound effect it can have on an individual's quality of life, the decision to adopt active surveillance in the face of a diagnosis of low-risk prostate cancer is understandable and probably unavoidable. MRI should play an increasingly important role in helping physicians and patients make that decision, and in managing those patients as they "watchfully wait." - Mike

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