Few physicians recommend active surveillance for low-risk prostate cancer

Oct 15 2012

Few physicians recommend active surveillance for low-risk prostate cancer rather than pursuing surgery or radiation, according to a Mayo Clinic study being presented at the North Central Section of the American Urological Association's annual meeting Oct. 10-13 in Chicago. Mayo Clinic urologists also are discussing findings on enlarged prostates, bladder cancer and other research and will be available to provide expert comment to journalists on others' studies.

Mayo studies being presented, and their embargo dates and times, include:

Active Surveillance for Low-risk Prostate Cancer Recommended Least Often by Physicians

While active surveillance is widely regarded as an effective strategy for managing low-risk prostate cancer, a Mayo Clinic study of 643 urologists and radiation oncologists found that only 21 percent of physicians studied recommended the strategy while 47 percent recommended surgery and 32 percent recommended radiation therapy.

Overall, physician recommendations aligned with their area of expertise. Most urologists recommended surgery, and most radiation oncologists recommended radiation therapy.

"Our results may explain in part the relatively low use of active surveillance for low-risk prostate cancer in the United States," says lead author Simon Kim, M.D., M.P.H., a urologic oncologist at Mayo Clinic.

Laser Surgery Relieves Symptoms After Unsuccessful Surgery for Enlarged Prostate

Holmium laser prostate surgery is safe and effective at relieving persistent lower urinary tract symptoms after an unsuccessful surgery to treat an enlarged prostate, a Mayo Clinic study has found. The laser surgery reduces the size of the prostate gland or increases the size of the channel through which urine flows.

The study compared surgical and postsurgical outcomes among patients who had a previous unsuccessful surgery for enlarged prostate and a group with no previous surgery.

"Other than a slower morcellation rate — the rate at which the laser removes tissue — and a slower average urine flow rate for patients who had a previous surgery, the study found no significant difference in outcomes between the groups," says urologist Amy Krambeck, M.D., the study's senior author.

Half of Urothelial Cancer Patients Who Get Surgery Aren't Cisplatin Chemotherapy Candidates

Nearly 50 percent of urothelial cancer patients receiving a radical cystectomy are not eligible to receive cisplatin-based chemotherapy before surgery, based on their kidney function alone, a Mayo Clinic study shows. Urothelial cancer is the most common form of bladder cancer in the United States.

The study also found that nearly one in five patients who were candidates for cisplatin-based chemotherapy before surgery were no longer eligible for it after surgery. Older patients and patients undergoing a continent urinary diversion, such as a neobladder, were more likely to have reduced kidney function after surgery.

The study included 741 patients with urothelial cancer who had a radical cystectomy at Mayo Clinic between 1980 and 2005. "This study highlights the fact that many patients who need a cystectomy for bladder cancer are not great candidates for cisplatin-based chemotherapy, both before and after surgery," says lead author R. Houston Thompson, M.D., a Mayo urologist. "It also is notable that after surgery some patients become ineligible for cisplatin-based chemotherapy, and this should be kept in mind as doctors counsel patients.

Source: Mayo Clinic