Office of Research & Development

VA RESEARCH QUARTERLY UPDATE
This Issue: The Aging Veteran | Table of Contents: Summer 2018 | Download this issue

Noteworthy Publications

Veterans benefit from conservative management of prostate cancer


In consultation with their doctors, more Veterans with prostate cancer are choosing to skip immediate surgery in favor of watchful waiting, according to a VA study. <em>(Photo ©iStock/relif)</em>
In consultation with their doctors, more Veterans with prostate cancer are choosing to skip immediate surgery in favor of watchful waiting, according to a VA study. (Photo ©iStock/relif)

In consultation with their doctors, more Veterans with prostate cancer are choosing to skip immediate surgery in favor of watchful waiting, according to a VA study. (Photo ©iStock/relif)

Veterans with low-risk prostate cancer are increasingly choosing to skip immediate surgery in favor of less aggressive treatment, according to results from a study published in JAMA.

Dr. Stacy Loeb at the VA NY Harbor Healthcare System and colleagues conducted a study of more than 125,000 Veterans diagnosed with low-risk prostate cancer. Reviewing claims data, they found that close to 60,000 Veterans were treated with a conservative approach. Nearly 38,000 men in this group received "watchful waiting," and slightly more than 22,000 received "active surveillance.”

The investigators found that use of conservative management in the VA health system for prostate cancer increased from 27 to 79 percent for Veterans under age 65, over a 10 year period. For men older than 65 years, conservative management increased from 35 to 79 percent over the same period.

"Our study shows that the VA health care system has done a good job over the last decade in adopting 'conservative management' of men diagnosed with early-stage disease," said Loeb, in a press release by NYU Langone Health. "This marks a historic reversal, at least in the VA, in the decades-long overtreatment of men with prostate cancers least likely to cause harm, and brings their care more in line with the latest best practice guidelines."

Recent guidelines put forth by the American Urological Association and the American Society of Clinical Oncology recommend a less aggressive approach to treatment for low-risk patients—one that holds off on surgery or radiation therapy.

Low-risk prostate cancer is slow growing and can often be safely observed through "watchful waiting" or more actively followed through "active surveillance"—a process that involves regular check-ups, blood tests, and biopsies.

The results of this study are in line with conclusions from the VA PIVOT study, which found that surgery did not result in a significantly lower death rate than observation for treatment of prostate cancer.


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