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Senior Citizen Health & Medicine
Large Study Finds Some Prostate Cancer Patients
Possibly Overtreated
Risks and benefits of immediate treatment not
always well-defined for less aggressive cancers
By Nicole Fawcett
University of Michigan Health System
August 15, 2006 - More than half of men with
lower-risk prostate cancer received surgery or radiation treatment when
a wait-and-see approach of no therapy and active surveillance would have
been a reasonable option, according to a new study from the University
of Michigan Comprehensive Cancer Center.
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For men with less aggressive prostate cancers, the
balance between the risks and benefits of immediate treatment with
surgery or radiation are not always well-defined. Research has shown
that older men with lower-risk prostate cancer who choose so-called
watchful waiting are 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.
Just as a failure to treat a potentially lethal
prostate cancer is generally considered inappropriate from a
quality-of-care perspective, overtreatment of lower-risk cancers is also
not in the patients best interest. For some men with early stage
prostate cancer, surgery or radiation therapy may result in substantial
negative effects without a survival benefit, says study author John T.
Wei, M.D., M.S., associate professor of urology at the U-M Medical
School.
The study appears in the Aug. 16 issue of the
Journal of the National Cancer Institute.
Researchers looked at 64,112 men diagnosed with
early stage prostate cancer, using the Surveillance, Epidemiology and
End Results registry, a population-based cancer registry maintained by
the National Cancer Institute. Men were divided into high-risk or
low-risk categories, based on characteristics of their tumors. Among the
24,835 men with lower-risk cancers, 55 percent were treated with initial
surgery or radiation, suggesting that aggressive treatment is quite
common even among men where an expectant approach is a viable option.
The researchers found that, among men with
lower-risk cancers, those under age 55 are more likely to be treated
with surgery versus watchful waiting. In contrast, men aged 70-74 were
more likely to be treated with radiation over watchful waiting. From
2000 through 2002, more than 13,000 men with lower-risk cancer received
treatment with surgery or radiation within the first several months
after diagnosis. Among this group, patients older than 70 with mid-grade
tumors were most likely to receive potentially unnecessary surgery or
radiation within the first year after diagnosis.
There are many men with prostate cancer who will
benefit from early treatment with surgery or radiation therapy. However,
prostate cancer is not a one-size-fits-all condition and we now know
that many men are diagnosed with slowly growing cancers that are
unlikely to cause symptoms or be fatal. Given that the average patient
often has bothersome side effects of surgery or radiation, it is
important to evaluate the barriers to greater use of expectant
management approaches including active surveillance, particularly among
this reasonably large group of men with lower-risk cancers, says 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.
Based on data from this study, it is clear that
the number of lower-risk patients who receive initial aggressive therapy
is not trivial and we have to ask the question whether this is too much
treatment for some of these men, Miller continues. We should continue
to explore our patients preferences regarding the different treatments
for early-stage prostate cancer and better educate them about the entire
spectrum of options, including the appropriateness of initial active
surveillance in many lower-risk cases.
The authors report that for many men with
lower-risk cancers a potentially appealing treatment option is called
active surveillance. Building on the traditional concept of watchful
waiting, active surveillance involves frequent monitoring of the tumor
without immediate active treatment. Active surveillance can help
distinguish between more-aggressive and less-aggressive cancers thereby
improving doctors ability to identify the patients most likely to
benefit from surgery or radiation.
Some 234,000 men will be diagnosed with prostate
cancer this year, and 27,350 will die from it, according to the American
Cancer Society. For information about
prostate cancer, or call Cancer AnswerLine at 800-865-1125.
In addition to Wei and Miller, U-M study authors
are Stephen Gruber, M.D., Ph.D., associate professor of internal
medicine, epidemiology and human genetics; Brent Hollenbeck, M.D.,
assistant professor of urology; and James Montie, M.D., Valassis
Professor of Urologic Oncology and chair of urology.
Funding for the study was from the
National Institutes of Health.
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