Men with low-risk prostate cancer are increasingly choosing to delay treatment, instead opting for what’s known as active surveillance, as medical guidelines now recommend, according to The New York Times.

Prostate cancer is the second most common cancer among men (after noninvasive skin cancer) and the second-leading cause of cancer death among men in the United States. This type of cancer typically grows slowly, and only a small proportion of men who develop the malignancy will die of it. Treatment may include surgery to remove the prostate gland (prostatectomy), radiation to shrink tumors and androgen-deprivation therapy (medications to block hormones that spur prostate cancer growth). But active surveillance, meaning delaying treatment while undergoing regular testing for cancer progression, has been growing in popularity, as the recent Cancer Health article “Many Men Can Delay Prostate Cancer Treatment” underscored.

In the past, men diagnosed with low-risk prostate cancer underwent aggressive treatment, such as surgery to remove the prostate gland or radiation, sometimes paired with hormone therapy. But a recent study revealed a shift in the past decade, with nearly 60% of men choosing active surveillance in 2021, compared with about 27% in 2014.

In another study published in the The New England Journal of Medicine, researchers found that men with localized prostate cancer who delayed treatment and underwent active surveillance had the same survival rate as those who had surgery or radiation therapy. What’s more, about 97% of men in the study survived 15 years after their diagnosis regardless of the chosen treatment method.

Prostate cancer typically grows slow enough that other illnesses are more likely to cause death first, the Times noted. In fact, guidelines from the U.S. Preventive Services Task Force and the American College of Physicians recommend against routine prostate cancer screening for men over 69 or 70 or for men with less than a 10- to 15-year life expectancy.

The American Urological Association recently updated its guidelines to recommend shared decision-making after age 69 to take into account life expectancy, age, risk factors and personal preferences.

“If you live long enough, prostate cancer is almost a normal feature of aging,” lead study author Matthew Cooperberg, MD, MPH, a urologic oncologist at the University of California, San Francisco, told the Times. “By the 70s or 80s, half of all men have some cancer cells in their prostates.”

Still, a study in JAMA Network Open showed that many men over 70 continue to undergo regular prostate-specific antigen screening for cancer, leading to unnecessary and costly tests for patients. Study authors say when people hear the word cancer, they often want to take immediate action.

Yet after 15 years, survival rates were similar for patients who were treated immediately and those who received active monitoring.

Some experts suggest using a less intimidating label for small, low-risk tumors in the prostate, such as indolent lesions of epithelial origin, or IDLE.

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