darren foreman

Senior Visiting Urologist Dr Darren Foreman is working on improving treatment options for men with low risk prostate cancer.

Working with the clinical prostate cancer databases of The South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC), supported by Australian Prostate Cancer), Dr Foreman has been studying active surveillance, a concept of prostate cancer management that involves identifying men with low risk prostate cancer and observing them on their journey.

“We know that prostate cancer varies between slow growing and aggressive. Active surveillance involves trying to identify the less aggressive cancers and following these men rather than treating them immediately,” Dr Foreman said.

“We follow these patients with regular PSA tests, clinical monitoring of their prostate, and appropriate imaging, and if there is any sign their disease is progressing we proceed with active treatment.”

Dr Foreman explains the side effects of curative treatments for prostate cancer may result in a decreased quality of life for patients, including incontinence and impotence. His study is evaluating whether a period of observation is safe in men with low risk prostate cancer. Ideally, he would like to be able to identify the group of men who will never require treatment for their indolent prostate cancer.

“Our study involves comparing the pathological outcomes of a group of men who began on active surveillance and progressed to treatment, with a group who immediately proceeded to treatment after diagnosis with similar disease characteristics.”

“We actually found there was a higher proportion of men whose cancer was spreading outside the prostate in the active surveillance group.”

“Our results have identified that a significant number of men who appeared to have a less aggressive cancer at diagnosis, were in fact underestimated. Despite this however, the clinical outcome was identical for the two groups. We were able to present our findings at an international Urology conference in Melbourne in October 2015.”

In order to refine the strategy of identifying men suitable for active surveillance, Dr Foreman is currently involved in the PRIAS trial at The Repatriation General Hospital, which is a multicentre international study evaluating criteria to improve identification of men suitable for active surveillance.

“Prostate cancer is the second largest cause of cancer death in men behind bowel cancer – it is a major problem. Through my study I want to be able to improve the information given to patients to ensure they can make an informed decision about treatment choice.”