Watch and wait the best option for low-risk prostate cancer

Aug 15 2006

According to the American Cancer Society, 234,000 men will be diagnosed with prostate cancer this year, and 27,350 will die from it, but researchers say that as many as half of men diagnosed with low-risk prostate cancer undergo surgery or radiation therapy unnecessarily.

The researchers from the University of Michigan Comprehensive Cancer Center, say that a policy of watchful waiting or "expectant management" i.e. regular checkups to see if treatment is necessary, is a more valid option for men with early-stage prostate cancer.

Dr. John T. Wei and his associates say that just as a failure to treat a potentially lethal prostate cancer is generally considered inappropriate, aggressive treatment of slow growing cancers may also be inappropriate as it exposes patients to other risks and increases costs without providing health benefits.

For the study Wei's team looked at information collected in national databases and identified 71,602 men diagnosed with localized or regional cancer of the prostate between January 2000 and December 2002.

The level of risk to the patients from their cancers was based on how clearly defined the tumor was (well-differentiated), rather than how spread-out it's indistinct boundaries were.

The lower risk group were classified as men of any age with well-differentiated tumors or men 70 years or older with moderately differentiated tumors.

According to the classification approximately a third of subjects (24,825) had a lower cancer risk and were good candidates for a watchful waiting approach, but they underwent immediate treatment, 45 percent received radiation therapy and 10 percent underwent surgical removal of the prostate which equated to overtreatment.

Wei's team says initial expectant management need not be a permanent treatment choice, and some men, in particular younger patients, should eventually proceed to appropriate curative therapy.

They therefore recommend "active surveillance with delayed intervention as an appealing approach to addressing overtreatment concerns among men with lower-risk prostate cancer".

For men with less aggressive prostate cancers, the balance between the risks and benefits of immediate treatment with surgery or radiation are not always clear and other research has shown that older men with lower-risk prostate cancer who choose so-called watchful waiting are often more likely to die from another cause during the first 20 years after their cancer diagnosis.

Meanwhile, surgery or radiation to treat prostate cancer can lead to complications such as erectile dysfunction, urinary incontinence and bowel difficulties.

Lead study author David C Miller, M.D., MPH, adjunct lecturer at U-M and now a health services research and urological oncology fellow at the David Geffen School of Medicine at UCLA, says that there are many men with prostate cancer who will benefit from early treatment with surgery or radiation therapy.

However, he says prostate cancer is not a one-size-fits-all condition and many men are diagnosed with slowly growing cancers that are unlikely to cause symptoms or be fatal.

The study is published in the Journal of the National Cancer Institute, August 16, 2006.