Findings from the 2018 annual report of the Movember Prostate Cancer Outcomes Registry - Australia and New Zealand (PCOR-ANZ) revealed that more than two thirds (69 per cent) of men diagnosed with low-risk prostate cancer during 2015-16 went on active surveillance.
However, the study found that the remaining 31 per cent of men with low-risk disease went on to have treatments they may not have needed. In men under 60, 42 per cent of men with low-risk prostate cancer chose active treatment over regular monitoring.
The report’s authors concluded that while the trend towards active surveillance, following evidence-based guidelines, is increasing, more needed to be done to encourage men with low-risk disease to consider it as a viable option where the evidence showed no impact on survival.
Treatments such as surgery and radiotherapy can carry life-changing side effects such as incontinence, problems with bowel function and erectile dysfunction. Active surveillance (AS) involves regular monitoring via Prostate Specific Antigen (PSA) blood tests, Digital Rectal Examinations (DRE) or in some cases MRI scans.
Commenting on the report, the Movember Foundation’s executive director of programs Paul Villanti said: “Improving the quality of life for men with prostate cancer is a key priority for Movember. One of the key ways of achieving this is to encourage men not to be treated for low-risk disease. It is pleasing to see continued progress in the levels of active surveillance in Australia. We will continue to work closely with the clinical community to understand and address the barriers to men with low-risk disease going on active surveillance.”
Professor Sue Evans, academic lead of the PCOR-ANZ registry said: “Men with low-risk prostate cancer could be spared long-term life changing side effects by choosing active surveillance rather than surgery or radiotherapy. The trend for choosing active surveillance is certainly a good thing and the registry can claim some credit for this. However, we want to see that trend increase further with the numbers of men opting for active surveillance above 90 per cent.”
Dr Peter Heathcote, president of the Urological Society of Australia and New Zealand (USANZ) said: “To improve the take up of active surveillance by men we need improved education and support in a shared decision-making framework.”
Australia and New Zealand have the highest incidence of prostate cancer in the world[i]. Around 18,000 men are diagnosed with the disease in Australia every year (3,400 in New Zealand) and the average age of diagnosis is 67. One man in five diagnosed with the disease will die from it.
The annual report, which is a collaboration between the Movember Foundation and Monash University, is endorsed and promoted by medical specialist colleges and associations — such as Urology (USANZ), Radiation Oncology (RANZCR) and Medical Oncology (MOGA) and Pathology (RCPA) — as well as Cancer Council Australia and Cancer Australia.
Paul Villanti added: “Thanks to the strong support and leadership of the Australian urology, oncology and pathology communities, PCOR-ANZ is now the largest national clinical quality registry in Australia, providing clinicians and hospitals for the first time with independent data to measure, benchmark and improve prostate cancer treatment and care. This data enables the clinical community to identify excellence in treatment and care approaches, as well as opportunities for improvement. This powerful national collaboration between clinicians, researchers and men living with prostate cancer is a model that many other cancer conditions are looking to emulate.”
To enable men to make more informed decisions about their treatment, the Movember Foundation will begin rolling out its TrueNTH digital health platform over the next year. It will provide health trackers, decision support tools and other resources for men with prostate cancer and their families so they can manage their own condition from home.
[i] Source: Movember Prostate Cancer Outcomes Registry Annual Report 2018, page 25
