New Study of Active Surveillance and Quality of Life

Cant bring up either link without it wanting you to sign up, does it cost any money?

I agree with Fairwind. I just saw a post where the biopsy showed Gleason 6 and the pathology report came out as an 8. I wouldn't want to be on AS with Gleason 8.

This editorial comment on the article mentioned above was not freely available, so I wrote my own summary of it (Yes, that is legal under copyright law)
On the Active Surveillance of Prostate Cancer

Based on editorial comment in JAMA on the article
Active Surveillance Compared With Initial Treatment for Men With Low-Risk
Prostate Cancer: A Decision Analysis
JAMA 2010;304(21):2373. JAMA Julia H. Hayes et al.

Before the mid 1980’s, when PSA testing became available most prostate cancer was already metastatic when it was diagnosed. The introduction of PSA testing lead to a doubling of the rate of diagnosis of prostate cancer, but many more of these cancers were at a curable stage. In fact, from 1990 to 2006 deaths from prostate cancer declined 39% in the U.S.

The trend today is to do biopsies at lower PSA scores than in the past. It is also common to take more cores per biopsy. The standard now is 12 compared to 6 in the past. We see more cancers diagnosed after several negative biopsies and we see more low grade cancers being diagnosed. While some have raised concern about overtreatment, over 90% of patients with low grade cancer receive treatment, generally surgery or radiation.

Current studies of active surveillance, where the cancer is not treated unless there is rapid PSA raise, or increase in tumor volume or tumor grade, suggest that AS adds about 3% increase to the risk of cancer death within ten years.

The authors of the study above have used past studies and quality of life estimates to conclude that AS adds, on average, 6 months to quality life expectancy. Because quality of life is subject to many definitions, the authors tested their conclusions with a wide range of assumptions but came to essentially the same conclusion They did, however, note that for some AS patients, anxiety decreases the quality of life enough that immediate treatment may be indicated. There is also concern that biopsy may miss more aggressive cells – 25 to 38% of diagnoses are upgraded when the entire prostate is examined. Finally, repeated biopsy exposes the patient to increased risk of urinary infection.

There are developments in studies of biomarkers specific to indolent tumors. There are also new developments in imaging which allow directed biopsy. Both of these will help physicians and patients to make better decisions about active surveillance.

John is correct -- this was a statistical analysis of existing data not an attempt to study new patients. The interesting part was the attempt to factor in quality of life and combine this with, what seem to me to be very solid probabilities of various outcomes. This was then combined with life expectancy predictions so that living fewer years in good health could be the equivalent of living more years in poor health. Thus, while active surveillance may slightly increase the risk of earlier death, it also increased the overall health before that death

Men were asked to rate quality of life on a scale from 0 (dead) to 1 (excellent health) here are some examples
Quality of life with
ED .88
incontinence .81
bowel problems .63
(lower numbers represent a poorer quality of life)

I think this is the kind of analysis that my grandfather made when his children urged him to change his unhealthy lifestyle: "You can watch to see how long I live, but also watch to see how happy"