For older men with low-risk prostate cancer, a new study adds to evidence that closely watching the tumor instead of immediately treating it may be a reasonable option.
In a study of more than 650 men with an average age of 66, most were able to go for five years without treatment for their prostate cancer, according to the report in the Journal of Clinical Oncology.
"The underlying problem is that we're over-treating prostate cancer because we don't have a perfect method of identifying those people that will never be harmed by their cancer," said Dr. H. Ballentine Carter, professor of urology and oncology at Johns Hopkins University School of Medicine in Baltimore.
"In general, the vast number of (prostate) cancers are of the slow-growing variety that a person could live with for years," Carter, who co-authored the study, told Reuters Health.
Prostate cancer screening through PSA (prostate-specific antigen) testing has helped find cancers that never would have caused problems, said Dr. Otis Brawley, chief medical officer of the American Cancer Society, who was not part of the study.
A PSA test costs about $20 to $30, Carter said.
The ease of using the test to screen men has led to growing concern that low-risk cancers are being overdiagnosed, particularly in older men more likely to die of some other cause before the prostate cancer ever becomes an issue.
Past studies have shown that prostate cancer screening doesn't help men live longer, and not treating the disease doesn't result in high death rates.
Based on these and other findings, the U.S. Preventative Services Task Force does not recommend screening men older than 75, and says there isn't enough evidence of whether it's useful for younger men.
For those men over 65 who are tested and diagnosed with a low-risk prostate cancer, "the first question is not how I'm going to treat, but if I'm going to treat or not," Carter said.
Ultimately, about one-third of the men in the study had treatment. The majority — about eight out of ten — put it off for two years, while six out of ten went for five years. There were no deaths from prostate cancer in the study.
The researchers used active surveillance, which means checking PSA levels and yearly biopsies. In this approach, if the tumor is found to have progressed, a man will then undergo treatment involving either surgery or radiation.
These treatments can lead to urinary or bowel incontinence and erectile dysfunction. Most men will have one or more of these side effects, but many lessen over time, according to the Prostate Cancer Foundation.
Surgery runs from $20,000 to $30,000, while radiation treatment can cost from $20,000 to $100,000, depending on the type, Brawley said.
The men in the study had been diagnosed with very low-risk prostate cancer. Researchers followed the men for as long as 15 years. At the end of the study, about 400 of the participants had had no treatment for their cancers, and about 250 did.
Each year, 157 out of 100,000 men are diagnosed with prostate cancer in the United States. Of these, 25 — or about one in six — will die from the disease, according to the National Cancer Institute. The average age of diagnosis is 67 years and the average age of death from prostate cancer is 80.
"If we delay treatment, the outcomes will be the same down the line as (treating) when we get the initial diagnosis. That looks to be the case," said Dr. Maxwell Meng, associate professor of urology at the University of California San Francisco.
"But can we predict which guys will need treatment or not? We're not as good at that right now," said Meng, who did not work on the current study.
Men with prostate cancer need to learn about all the different types of treatments and talk to a number of doctors, Meng told Reuters Health.
"Some cancers may not need immediate treatment," he said. "It may be safe to watch if that's what (the patient) wants to do."
No comments:
Post a Comment