Page 39 - Encyclopedia of Nursing Research

6 n ACTivE SURvEiLLANCE FoR PRoSTATE CANCER

than ten years. in addition, they have also The primary outcome, disease-specific sur-
defined a group at very low risk and recom- vival, will not be available until 2025. Lastly,
A mend that these men with a life expectancy of the Prostate Cancer Research international:
less than 20 years only receive active surveil- Active Surveillance study, a Web-based
lance. These guidelines use life expectancy trial, will provide important information
as an important variable in the active surveil- on changes in PSA values and kinetics (van
lance decision-making discussion. However, den Bergh et al., 2007). These studies have
for younger men, the question of appropri- the potential to address important questions
ateness remains open and will require addi- related to the selection of active surveillance.
tional data. The hope is to improve selection Because these answers are at least 10 years in
criteria to include younger men who wish to the future, men will continue to make their
preserve their quality of life. decision to elect a course of active surveil-
Although men undergoing active sur- lance with limited evidence.
veillance may eventually need traditional The urologic medical community and
therapy, the delayed time to treatment nurse scientists investigating the effects of
leaves quality of life intact and may result in active surveillance continue to advocate for
improved treatment in the future. in a recent research that will help men make informed
report, Duffield, Lee, Miyamoto, Carter, and treatment decisions and then offer theoreti-
Epstein (2009) found that the 48 men of 470 cally based interventions to help them man-
who opted for treatment within an average age the psychological aftermath inherent in
timeframe of 2.5 years (range = 1–6 years), 31 a course of close monitoring for early stage
(66%) had organ-confined disease, 17 (35%) prostate cancer (Kazer, Bailey, Colberg, Kelly,
and 3 (6%) had extraprostatic extension and & Carroll, 2011). This concern occurs within
seminal vesicle involvement, respectively, the ongoing debate regarding PSA testing and
and 7 (15%) had positive margins at the time which treatment really is better for men with
of surgery. However, up to 50% of men may early stage disease. Although the selection
opt for care in the absence of disease progres- of active surveillance by men in the United
sion (Klotz, 2005). States continues to decline (Moul, Mouraviev,
There are four large randomized clin- Sun, Schroeck, & Polascik, 2009), urologists
ical trials that are attempting to determine and cancer centers will offer patient selection
the benefits of active surveillance for local- guidelines on the basis of current but incom-
ized prostate cancer. The Prostate Testing plete evidence. Eggener et al. (2009) found that
for Cancer and Treatment trial has enrolled only 1 of 262 patients who initiated a course
approximately 109,750 as of 2008 from the of active surveillance developed bone metas-
United Kingdom to determine which of tases at 38 months. Forty-three additional
three treatments, active surveillance, pros- patients initiated traditional therapy during
tatectomy, or conformal radiotherapy, is the the follow-up period of 29 months. Being able
best. This study will follow men for 10 to to adequately predict a man’s disease risk
15 years (Bastian et al., 2009). The Canary would improve the likelihood that increasing
Prostate Active Surveillance Study is a mul- numbers of men would view active surveil-
ticenter study that seeks to determine the lance in a favorable light (Klotz, 2009). Until
aggressive prostate cancers that progress on we have the evidence to accurately identify
active surveillance from those cancers that the most appropriate men for active surveil-
will remain indolent (Newcomb et al., 2010). lance, the selection of this treatment strategy
The Surveillance Therapy Against Radical will remain underutilized, and the overtreat-
Treatment, a multicenter Phase 3 trial, will ment of prostate cancer will persist.
enroll 2,130 men into either active surveillance
or aggressive treatment (surgery or radiation). Donald E. Bailey