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It appears that men diagnosed with low-risk prostate cancer who choose active surveillance instead of initial treatment may enjoy a better quality of life. These findings were recently reported in the Journal of the American Medical Association.

The prostate is a male sex gland responsible for producing fluid that forms semen. It is located below the bladder, in front of the rectum, and surrounds the urethra. Prostate cancer occurs when the cells in the prostate gland grow out of control.

Men with early-stage prostate cancer have the option of being treated aggressively, which may include radiation therapy or surgery to remove the prostate (radical prostatectomy), or conservatively, which may involve no therapy until symptoms appear (active surveillance). The choice of treatment can be difficult; for men with low-risk prostate cancer, there is no clear proof that early treatment prolongs survival compared with treatment that is deferred until there is evidence of disease progression. Active surveillance may help some men avoid unnecessary treatment and potentially long-lasting side effects.

To evaluate the quality-of-life outcomes of active surveillance compared with initial treatment among men diagnosed with prostate cancer, researchers used a simulation model (using data from previous studies and literature reviews) to study outcomes in men 65 years of age. Initial treatment included brachytherapy (radiation therapy using radioactive seeds implanted near the tumor), intensity-modulated radiation therapy, or radical prostatectomy. Active surveillance included monitoring with measurements of prostate-specific antigen, digital rectal exam, and biopsies; treatment was given at signs of disease progression or by patient choice.

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Patients on active surveillance had the highest probability of the best quality of life. Radiation therapy and radical prostatectomy followed (in that order) for the estimated quality-of-life standards. However, it was noted that optimal treatment strategies would be guided by personal preference.

Based on assumptions from this simulation model comparing active surveillance to initial treatment in 65-year-old men with low-risk prostate cancer, it appears that active surveillance is a reasonable option.

Reference:  Hayes JH, Ollendorf DA, Pearson SD, et al. Active surveillance compared with initial treatment for men with low-risk prostate cancer. JAMA. 2010;304(21):2373-2380. doi: 10.1001/jama.2010.1720.

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