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‘Watchful Waiting’ Is Safe, Cost-Saving in Low-Risk Prostate Cancer
Many men with low-risk, localized prostate cancers can safely choose active surveillance or “watchful waiting” instead of undergoing immediate treatment and have better quality of life while reducing health care costs, according to a study by researchers at the Dana-Farber Cancer Institute and the Massachusetts General Hospital.
Writing in the June 18 issue of the Annals of Internal Medicine, the authors said their statistical models showed that “observation is a reasonable and, in some situations, cost-saving alternative to initial treatment” for the estimated 70% of men whose cancer is classified as low-risk at diagnosis.
The researchers, led by medical oncologist Julia Hayes, MD, said their findings support observation — active surveillance and watchful waiting — as a reasonable and underused option for men with low-risk disease.
Hayes and her co-authors created mathematical models to construct a variety of scenarios, focusing on men aged 65 or 75 years at diagnosis, and including estimated costs associated with treatment and different forms of observation.
In active surveillance, patients undergo blood tests for prostate-specific antigen (PSA) every 3 months, rectal examinations every 6 months, and a prostate gland biopsy at 1 year and then every 3 years. If the tests find the cancer is more aggressive than originally thought, the patients begin treatment aimed at curing the disease.
A patient who chooses watchful waiting is observed without intensive monitoring and is given palliative treatment when the cancer becomes symptomatic.
Treatments for low-risk prostate cancer include radical prostatectomy, intensity-modulated radiation therapy (IMRT), or brachytherapy (radioactive seed implants).
The investigators calculated the quality-adjusted life expectancy (QALE) for the different strategies. They also estimated the lifetime costs of each strategy, which ranged from $18,302 for watchful waiting for men aged 75 years to $48,699 for a 65-year-old patient treated with IMRT therapy.
The bottom-line result was that observation was more effective and in some cases less costly than initial treatment for low-risk prostate cancers. Watchful waiting yielded 11 months of additional QALE over brachytherapy — the most effective treatment — and 13 months of additional QALE over radical prostatectomy, the least effective treatment.
Source: Dana-Farber Cancer Institute; June 17, 2013.