While men with early-stage prostate cancer can delay treatment, few follow guidelines for monitoring their condition, researchers report.

In fact, their study of nearly 350 men from North Carolina found that only 15% who chose what's known as active surveillance followed the recommended guidelines.

"Active surveillance has rigorous guidelines -- people need regular PSA tests, they need prostate exams, they need prostate biopsies so you can watch the cancer very closely, and you don't lose the opportunity to treat the cancer when it starts to grow," said study co-author Dr. Ronald Chen. He's an associate professor from the University of North Carolina Lineberger Comprehensive Cancer Center in Chapel Hill.

Guidelines recommend prostate-specific antigen (PSA) tests at least every six months; a yearly digital rectal exam, and a biopsy within 18 months of diagnosis.

"We're finding very few patients who elected to undergo active surveillance actually received the recommended monitoring," said first author Sabrina Peterson, a UNC medical school student.

Among 346 men with low- or intermediate-risk prostate cancer, the study found that within six months of their diagnosis, 67% had undergone a PSA test and 70% had a digital rectal exam.

But only 35% had the recommended biopsy during the first 18 months. Over two years, only 15% had undergone all the recommended tests.

It wasn't clear why so few men followed the guidelines, the researchers said. No connection was seen with income, race or age.

"This raises the question of whether we need to investigate whether active surveillance is a safe option when patients do not receive routine monitoring," Chen said in a university news release. "Our goal is not to reduce the number of patients choosing active surveillance; rather, the results of this study should increase awareness and efforts to ensure that active surveillance patients are monitored rigorously."

Chen and his colleagues also investigated why men would or wouldn't choose active surveillance. They found that men opted for treatment when their cancer began to progress.

Patients who were anxious about their cancer were also more likely to stop active surveillance and switch to treatment, the researchers found.

The preliminary findings were presented Sunday at a meeting of the American Society of Clinical Oncology, in Chicago. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

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