VA Reduces Treatments of Non-Aggressive Prostate Cancer

Researchers suggest salaried physicians at the publicly funded hospital system are not financially incentivized to overtreat patients with costly and unneeded surgeries or radiation therapy. 

The Veterans Affairs health system has made tremendous progress over the past decade in convincing patients to postpone surgery or radiation for non-aggressive prostate cancer, new research shows.

Instead, strong majorities of VA patients are opting for active surveillance of the slow-growing cancer, which relies on regular check-ups, blood tests, and occasional needle samplings of prostate tissue to check for any signs of a tumor getting worse.

The researchers used data from the VA's Central Data Warehouse, in one of the largest studies of its kind, involving a review of the medical records of 125,083 former servicemen, mostly over the age of 55, who were newly diagnosed with low-risk prostate cancer between 2005 and 2015.

Researchers found that:

• In 2005, 27% of men under age 65 passed on immediate therapy, and 4% chose active surveillance.
   
• In 2015, 72% passed on immediate therapy, and 39% choosing active surveillance.  

"Our study shows that the Veterans Affairs health care system has done a good job over the last decade in adopting 'conservative management' of men diagnosed with early-stage disease, with many men choosing active surveillance as an alternative to immediate therapy," says study senior investigator Stacy Loeb, MD, a urologist.

"This marks a historic reversal, at least at 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," Loeb says in comments accompanying the study.

Loeb credits the VA’s success to several factors, and noted that it is part of a national network of publicly funded hospitals, where many physicians are salaried, so there is little financial incentive to overtreat.

"The main conclusion to be drawn from the data is that if so many veterans can quickly adopt this less-risky disease-management strategy, then so too might other American men if they understood the potential benefits of this option," she says.

Editor's note: The headline of this story was updated Friday, May 18, 2018, to clarify that "non-aggressive" describes certain cases of prostate cancer.