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More men with low prostate cancer reject aggressive treatment, new study suggests



There is a change in men at low risk for prostate cancer: More and more people are avoiding immediate surgery or radiation and instead opt for close monitoring of the condition to determine if the condition is getting worse. The shift reduces the unnecessary treatment, which can cause serious side effects like incontinence and sexual problems, experts say, without increasing the risk of death.

The latest evidence for the long-term trend came in a major study released on Tuesday More than 125,000 veterans who were diagnosed with non-aggressive prostate cancer between 2005 and 2015. Researchers found that in 2005, only 27 percent of men under the age of 65 waived immediate therapy and instead "watchful waiting" or "active monitoring" recorded the tumor. By 201

5, the situation had changed – 72 percent refused immediate surgery or radiation in favor of such monitoring. The data for men older than 65 were similar.

The study, which appeared in JAMA, was conducted by researchers at NYU Langone Health and Veterans Affairs NY Harbor Healthcare System.

"I think it's very important," said Otis Brawley, chief physician of the American Cancer Society, who was not involved in the study. "Remember, until 2010, a man diagnosed with prostate cancer was told to get her prostate by next week at the latest."

Brawley, who has long warned of the dangers of prostate and breast cancer overdose, said the study shows that efforts are beginning to pay off to convince patients that some low-risk malignancies do not require immediate aggressive responses , And he said the study is a leading indicator of where the rest of the country is going. About half of non-VA patients with the same type of malignancy now refuse immediate treatment and the number is growing rapidly

"The VA is the tip of the spear," he said. "In five years, the whole country will be at 70 percent."

Stacy Loeb, who led the study and is a urologist at NYU and the Manhattan Veterans Affairs Medical Center, said the change "represents a historical reversal, at least in the VA, in decades of over-treatment of men with prostate cancer the least damage and bring their care more in line with the latest best practice guidelines. "The guidelines include recommendations issued in recent years by the American Urological Association and the American Society of Clinical Oncology.

Over the years, most of the surveillance-only arm has been in a category called "active" instead of "monitoring," in which men are more closely monitored and tested than those in "watchful waiting." "While 4 percent of men chose active surveillance in 2005, 39 percent chose it in 2015, as the study showed."

The researchers said there were many reasons why VA rated national guidelines higher than other parts of the organization Country health care system – including the lack of financial incentives for salaried physicians to recommend more aggressive treatment.

Jonathan Simons, president of the Prostate Cancer Foundation, who helped fund the study, said that while the VA health care system has some problems when it comes to the "no. 1 cancer of veterans, prostate cancer comes, the results are better in VA hospitals than in the rest of American medicine. "

Clark Howard, a resident of Atlanta, writes and makes a radio broadcast about consumer issues, was one of the first patients for He was diagnosed with low-risk prostate cancer at the age of 53 in 2009, and his doctors urged him to schedule an operation immediately, and he refused.

"My wife thought I was crazy and burst into tears, "he said," I've never seen her scream and cry so much, she was so angry. "

As part of monitoring his cancer, Howard gets PSA (prostate-antigen-specific ) Tests and biopsies every two years He also had two MRI-based tests, his cancer did not get worse, and if that's the case, he says, then he'll be treated. "So many people are con That cancer must be treated aggressively and immediately, and if you do not, you will die. "

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