Delayed surgical treatment may combat overtreatment of prostate cancer

Delayed surgical treatment for patients with small, low-grade prostate cancer tumors was not associated with lowered curability, according to a study in the March 1 issue of the Journal of the National Cancer Institute.

Men who receive screening with prostate specific antigen (PSA) for prostate cancer are diagnosed about 10 years earlier than men who do not receive PSA screening. Early diagnosis may have contributed to a decrease in prostate cancer mortality, but it may also result in diagnoses of cancer that would never have become clinically apparent. Some researchers have suggested that active surveillance programs (i.e., delayed treatment) might decrease overtreatment for men diagnosed with prostate cancer on the basis of PSA screening, but there are concerns that surveillance could lead to increases in inoperable tumors.

H. Ballentine Carter, M.D., and colleagues at the Johns Hopkins University School of Medicine in Baltimore, enrolled a group of 320 men suspected of having small, lower-grade prostate cancer in an active surveillance program, 38 of whom underwent delayed surgical intervention after a median of 26.5 months between 1995 and February 1, 2005. Outcomes in this cohort of 38 men were compared with those of a group of 150 patients given immediate surgical treatment after a median of 3 months.

Risks of noncurable prostate cancer, as defined by having a less than 75% chance of remaining disease-free 10 years after surgery, were equivalent in men who received immediate or delayed surgical treatment. Variables associated with risk of noncurable prostate cancer included age at time of diagnosis, PSA level, and PSA density (i.e., PSA level divided by prostate volume). The authors suggest that men diagnosed with early-stage, low-grade prostate cancer have an alternative to immediate surgical treatment, because these men have an equivalent risk of noncurable prostate cancer if surgery is delayed for up to two years after diagnosis, with the use of active surveillance as a management program.

The authors write, "Expectant management with curative intent appears to be a safe alternative to immediate treatment for a carefully selected group of patients with small-volume, lower-grade prostate cancer."