Detroit - The American Cancer Society has awarded Wayne State University School of Medicine researcher and clinician Jinping Xu, M.D., M.S., a five-year, $1.76 million Research Scholar Grant (RSG-13-164-01-CPPB) to analyze how men with low-risk localized prostate cancer choose to manage their disease.

Xu, a School of Medicine associate professor of family medicine and public health sciences, and a physician with the Wayne State University Physician Group's Family Medicine practice in Rochester, Mich., will lead the team on the project "Why Don't More Men with Low-Risk Prostate Cancer Choose Active Surveillance?"

"We are all very excited about the opportunity to carry out this longitudinal, population-based cohort study of men with newly-diagnosed prostate cancer, which we believe has the potential for impact on both public health policies and clinical practices of taking care of men with prostate cancer," Xu said.

The United States Preventative Services Task Force issued new recommendations last year against Prostate-Specific Antigen screening of healthy asymptomatic men, asserting that it caused more harm than benefit, primarily because of overtreatment. The new guideline sparked intense media coverage and a national debate on medical decision-making and the benefits of active surveillance as an appropriate management strategy for low-risk localized prostate cancer to decrease the harms of overtreatment, Xu said.

The study will identify determinants of treatment choice in men with low-risk localized prostate cancer, including the factors that affect the offer, acceptance and adherence of active surveillance as an initial management strategy. Localized cancer means there is no sign it has spread outside the prostate. Four out of five prostate cancers are found at this stage, according to the National Cancer Institute.

Active surveillance involves delaying treatment until test results show the cancer is growing or changing. The cancer is checked regularly, such as every three to six months at first.

Prostate cancer is the most commonly diagnosed non-skin cancer in men in the United States. One in six men will received the diagnosis in their lifetime, according to the most recent data available from the National Institutes of Health. The 10-year relative survival rate is 98 percent, according to the American Cancer Society.

"Active surveillance offers the opportunity to delay or avoid curative treatment and associated side effects unless the cancer progresses," said Xu. "Current practice guidelines identify active surveillance as an appropriate initial management strategy for low-risk localized prostate cancer. However, active surveillance is rarely chosen, and little research has addressed the reasons why men with low-risk prostate cancer receive aggressive treatment rather than active surveillance. In addition, while black men historically have received less aggressive prostate cancer treatment than whites, they also report having more decision-making difficulty, decision regret and poorer quality of life."

African-American men are twice as likely as Caucasian men to die from prostate cancer, according to the NCI.

The team also will survey urologists to understand how and why treatment decisions are made, with a focus on the urologist's offer, and the patient's acceptance and adherence of active surveillance. She expects the findings will provide a foundation for targeted efforts to optimize men's treatment decisions and improve quality of life, while reducing racial disparity in prostate cancer treatment and outcomes.

The study will use a culturally-sensitive patient survey culled from a previous five-year pilot study on racial disparities in prostate cancer treatment decision-making, also funded by the American Cancer Society.

Co-investigators include the Department of Family Medicine and Public Health Sciences' Professor Kendra Schwartz, M.D.; Assistant Professor and  Biostatistician James Janisse, Ph.D.; Professor and Biostatistician Joe Ager, Ph.D.; WSU Associate Professor Susan Eggly, Ph.D., of the Barbara Ann Karmanos Cancer Institute; WSU Assistant Professor of urology Jeffrey Triest, M.D.; and Michael Goodman, M.D., M.P.H, associate professor of epidemiology at Emory University, Atlanta, and medical director of Emory's Georgia Center for Cancer Statistics.

Researchers will recruit about 2,000 men in Michigan and Georgia identified from cancer registries sponsored by the NCI.
 

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