John Leppert, MD, Co-Authors New Study on Overtreatment of Prostate Cancer Published by JAMA Internal Medicine

JAMA Internal Medicine has published a new study, 'Overtreatment of Prostate Cancer Among Men With Limited Longevity in the Active Surveillance Era,' co-authored by Stanford Urology Professor, John Leppert, MD.

There is a growing interest in precision medicine - delivering the right care to the right patient at the right time. Part of these efforts are knowing when you can avoid treatment (and the risks and toxicities of treatment). “Overtreatment” refers to treating a condition where the patient is unlikely to receive benefit from that treatment. Avoiding the overtreatment of patients diagnosed with indolent, slow growing cancers has been a remarkable success story. For example, most patient diagnosed with low risk prostate cancer now go active surveillance treatment regimens (instead of receiving surgery or radiation which carry significant and important side effects). But there are 2 reasons that a cancer patient may not need aggressive treatment. One is that some cancers are so indolent, that they are unlikely to cause any health effects (and that is the case for low risk prostate cancer). The other is that the cancer patient is not in optimal health , and is unlikely to live long enough to receive the benefits of treating a cancer.

In this paper, researchers examine trends in the use of aggressive treatment (surgery or radiation) for Veterans with prostate cancer receiving care in the VA. While the overtreatment of low-risk prostate cancer in healthy men has been dramatically reduced in recent years, this study shows that the overtreatment of men diagnosed with prostate cancer who have a limited life expectancy is actually increasing. This overtreatment, primarily involving radiotherapy, continues even though many patients have a life expectancy too short to benefit from such aggressive treatments. The findings highlight the need for better alignment between treatment decisions and patient life expectancy if we are going to realize the goal of personalized precision medicine and cancer care.

Question?

Is overtreatment of prostate cancer with definitive local therapy among men with limited life expectancy in the US Department of Veterans Affairs (VA) health system increasing in the active surveillance era?

Findings

In this cohort study of 243 928 men with clinically localized prostate cancer in the VA health system, overtreatment of low-risk prostate cancer with surgery or radiotherapy decreased, whereas overtreatment of men with limited life expectancy and intermediate-risk or high-risk disease increased, mainly with radiotherapy.

Meaning

The study results suggest that despite a marked reduction in overtreatment of low-risk prostate cancer in the VA in association with adoption of active surveillance, clinicians should also avoid definitive treatment of men with limited life expectancy to prevent unnecessary toxic effects in men with insufficient longevity to benefit from treatment.