Men's Health: Most With Low-Risk Prostate Cancer Choose Treatment
Men with prostate cancer in its earliest stage have a tough choice: Treat the disease, even though it may never progress to be a health threat, or wait and monitor it for signs that it's spreading. Despite a low risk of spread and the potential unpleasantness of surgery, radiation therapy, or chemo, a new study finds that only a small fraction of eligible men opt for so-called watchful waiting.
Researchers analyzed data taken from a national registry of men treated for prostate cancer and found that of 1,886 men diagnosed with the disease between 1999 and 2004, about one sixth had very low risk disease that qualified them for watchful waiting (also known as active surveillance). But of those 300-odd men, just 9 percent opted for surveillance, which includes regular physical exams and monitoring of prostate-specific antigen (PSA) levels. Older men were more likely to choose watchful waiting, which makes sense; because prostate cancer grows slowly, older patients with the earliest signs of disease are more likely to die from other causes than from the cancer itself.
The authors, led by Daniel Barocas, chief resident in urology at New York-Presbyterian Hospital-Weill Cornell Medical College, called waiting an "underutilized strategy." Barocas presented the study at the Prostate Cancer Symposium in Orlando, Fla. But he acknowledged that it's a challenge to improve the accuracy of predicting which cancers will grow and spread and which will remain tiny and confined to the prostate. Other studies have suggested that around 94 percent of men deemed to be low risk based on PSA levels and amount of tissue containing cancer will be fine; the rest face about a 1 in 4 risk that the tumor will have spread beyond the prostate after it's removed. "The risk is that you'll wait and watch them until they're beyond the point of treatment," says Barocas. Researchers are looking for specific genetic or molecular markers that better indicate prognosis.
Separately, other researchers have determined that the discovery of increasing numbers of early-stage prostate cancers, attributed to widespread screening using the PSA test, is leveling off. Whereas once most cancers weren't found until they'd spread beyond the prostate, now about 75 percent are detected when they're still tiny and confined to the organ, says Eric Klein, head of urologic oncology at the Glickman Urological Institute of the Cleveland Clinic Foundation and an author of the study. Survival rates for the disease have improved as a result, but that progress may be over. "We're not going to see major gains in cure rates beyond what's already achieved based on PSA screening," he said at a press conference. "That will require true new therapeutic advances in radiation and surgery."
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