“What treatment do most patients choose?” Occasionally I’m asked this question, so I thought it would be interesting to present some statistics from published studies.

2011 data (low risk PCa)

I’ll start with data presented in a 2011 article by a British team.^[i] The authors collected records on 768 of their center’s patients with early stage, low-risk prostate cancer (PCa). Even though the study is more than 10 years old, I like it because it reveals the predominant reasons for each choice.

• 305 (40%) chose prostatectomy, primarily because they needed to feel their PCa had been physically removed and was therefore presumed gone (reason given by 60%).
• 237 (31%) chose conformal beam radiation due to fear of other treatments (reason given by 27%).
• 165 (21%) opted for brachytherapy due to lifestyle convenience (reason given by 39%)
• 61 (8%) went on active surveillance (various reasons, none predominant)

2015 data (predominately stage T1-T2 PCa)

The second study was a large population-based calculation, and though it was published later than the first, the observation periods overlap. In this study, records were obtained from a national U.S. database of 37,621 men diagnosed between 2004-07 and followed through the end of 2009. Most of the patients (90+ %) were considered low-risk. Treatment choices were as follows:

• 57.9% chose radiation
• 19.1% chose prostatectomy
• 9.6% opted for active surveillance or watchful waiting.^[ii]

These percentages add up to 86.6% of the total population, and the rest are unaccounted for. Since the proportions of the top two choices (surgery, radiation) differ from the 2011 study, perhaps it reflects differences in British and American medical standards of care during this period for early stage PCa. In any case, there’s a notable divergence in the prostatectomy and radiation numbers between the two studies.

2024 data (intermediate-risk PCa)

The third study is the largest and most recent, and focuses on the ongoing trend toward more use of active surveillance, even among intermediate-risk patients. Again, a national U.S. database provided records on 289,584 patients diagnosed from 2010-2020. The analysis showed:

• 153,726 (53.1%) had prostatectomy
• 101,152 (37.0%) had radiation
• 15,847 (5.5%) initially went on active surveillance.

The authors emphasize the increase in active surveillance over the study duration:

Overall, active surveillance quadrupled from 418 of 21 457 patients (2.0%) in 2010 to 2428 of 28,192 patients (8.6%) in 2020 for the entire cohort. Active surveillance increased from 317 of 12,858 patients (2.4%) in 2010 to 2020 of 12,902 patients (13.5%) in 2020 in men with favorable intermediate-risk prostate cancer. In the unfavorable intermediate-risk cohort, active surveillance increased from 101 of 8181 patients (1.2%) in 2010 to 408 of 12,861 patients (3.1%) in 2020.^[iii]

Yes, active surveillance has increased during the last decade, but the proportion is still quite small compared with the number of patients who chose a whole-gland treatment.

Unfortunately, focal treatment is not represented in any of these studies. Today’s MRI-guided focal therapy is a happy medium between the all-or-nothing choice: whole-gland treatment or active surveillance. The most advanced focal methods (Focal Laser Treatment, TULSA, and Exablate) offer precise cancer control with very high rates of preserving continence and erectile function. Our Center is pleased to be able to provide all three, in order to match the best option with each patient’s unique clinical factors and lifestyle preferences.

It is my belief that as national databases integrate the case records of the countless men who chose focal therapy, particularly from 2015 onward, we will see the data begin to shift away from prostatectomy, radiation and active surveillance exclusively.

Finally, our patients at the Sperling Prostate Center are highly satisfied with their choice of an MRI guided focal treatment, and are committed to our monitoring protocol following treatment. I look forward to the day when studies like the three cited here include focal treatment as well as the other choices. When that happens, the proportion of patients who opt for each treatment will cover the full spectrum of today’s prostate cancer treatments.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Anandadas CN, Clarke NW, Davidson SE, O’Reilly PH et al. Early prostate cancer–which treatment do men prefer and why? BJU Int. 2011 Jun;107(11):1762-8. https://pubmed.ncbi.nlm.nih.gov/21083643/
[ii] Chamie K, Williams SB, Hu JC. Population-Based Assessment of Determining Treatments for Prostate Cancer. JAMA Oncol. 2015;1(1):60–67. https://jamanetwork.com/journals/jamaoncology/fullarticle/2118569
[iii] Diven MA, Tshering L, Ma X, Hu JC, Barbieri C, McClure T, Nagar H. Trends in Active Surveillance for Men With Intermediate-Risk Prostate Cancer. JAMA Netw Open. 2024 Aug 1;7(8):e2429760.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11342134/