What’s the best way to improve the chances of surviving low-intermediate risk prostate cancer in 2018?
“The real question is what men can expect from treatment and the outcomes of treatment,” said Peter Carroll, MD, MPH, professor and Chair of Urology at the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center. “We need more treatment information and more transparency with regard to what men can expect from treatment. Patients want more information before they are treated about what they can expect after they are treated.”
Dr. Carroll and 10 colleagues from around the country will explore the range of treatment and surveillance options during Friday’s 90-minute Survivor Debate: Low-Intermediate Risk Prostate Cancer, which begins at 3:30 pm and will conclude the Prime Time plenary session in the Esplanade Ballroom at Moscone South.
“This one session will provide a very quick, clear, focused and practical overview of what is happening with early stage prostate cancer in 2018,” Dr. Carroll said. “The information we present will be actionable and we will address the questions that are most relevant to attendees and to their patients. We have a group of experts representing all facets of urology focused on a single topic that is immediately relevant to all in the field.”
Prostate cancer treatment, like so much of urology, is in flux as a result of recent advances in research and research tools — and nowhere more than in early stage disease. Genomics data, more precise imaging and other advances that may seem complicated at first glance have contributed to improved diagnostic, prognostic and treatment options.
It wasn’t long ago that outcomes from low-intermediate risk prostate cancer were anybody’s guess. Clinicians recognized that men with the lowest risk disease tended to die with prostate cancer rather than of it, but it wasn’t clear just what constituted low risk disease and there was little evidence of the most effective ways to deal with low risk disease. And as risk increased from low to intermediate, there were more questions and fewer satisfactory answers.
“Now we have pretty good information on what to expect, depending on the patient, their age, their overall health, personal preferences as well as their tumor characteristics,” Dr. Carroll said. “We can predict, with reasonable accuracy, what they may experience with regard to disease control, the need for secondary treatment and some of the side effects of treatment, whether it be surgery, radiation or hormonal therapy.”
That assumes active treatment is the chosen option. For a growing proportion of men, active surveillance is a viable, even preferable, option compared to active treatment.
Although most recent data on active surveillance comes from selected, large centers, Dr. Carroll said it seems applicable generally. There’s growing agreement as to which men may be better candidates for active surveillance, when they should be concerned, the likelihood of requiring some sort of active treatment in the future and the likely outcome if active treatment is needed at some point.
“This is all very new information,” Dr. Carroll said. “We will be able to bring greater clarity about the various treatment and surveillance options to urologists and provide them a real world picture of what they can tell their patients about the likelihood of requiring treatment and whether or not delayed treatment is associated with any negative outcomes given their specific personal and disease characteristics. This will be of substantial value to Annual Meeting attendees and to their patients.”