Study Suggests Many Men With Prostate Cancer May Be Overtreated
Common treatment options for ]]>prostate cancer]]> include ]]>surgery]]> , ]]>radiation therapy]]> , or “watchful waiting.” In watchful waiting, men with prostate cancer are monitored closely, and surgery and/or radiation therapy is delayed until symptoms worsen or the cancer begins growing more quickly. Watchful waiting is often recommended in men with lower risk prostate cancers (eg, less advanced cancers, cancers in older men), since research has shown that watchful waiting may be a safe alternative to immediate treatment in these men.
In a new study in the August 16, 2006 issue of the Journal of the National Cancer Institute , researchers examined how men with prostate cancer were treated. They found that more than half of men with lower risk prostate cancers were initially treated with surgery or radiation.
About the Study
Researchers from the University of Michigan used 13 cancer registries to identify 71,602 men who were diagnosed with prostate cancer from 2000-2002 and had a definite tumor “grade” recorded in a national cancer database. The cancers were classified as being lower or higher risk, depending on “stage” and “grade” (measurements used to assess how advanced the cancer is) as well as the participant’s age. The researchers determined whether treatment within the first year after diagnosis was surgery, radiation therapy, or watchful waiting. Since the cancer registries used for this study did not record whether the men received androgen deprivation therapy (ADT, a hormonal therapy used to treat prostate cancer), the watchful waiting group included some men who had received ADT.
The researchers classified 24,405 (34%) of the men as having lower risk prostate cancers. Among these men, 55% received surgery or radiation as their initial treatment. Over 2,500 had extensive surgery known as “radical prostatectomy,” and over 10,000 had radiation therapy. For this study, all men in the lower risk group who received surgery or radiation were considered “overtreated.” Based on this, the researchers determined that the greatest burden of overtreatment was among men ages 70 and older with moderately differentiated cancers (the most common type of cancers detected by screening).
A fact not emphasized by the authors is that for low-risk tumors diagnosed in men over age 55, watchful waiting was still the most common single treatment choice. For example, more than 80% of men over age 75 with low grade tumors chose watchful waiting. Even at ages 55-59, 35% chose surgery and watchful waiting. Nonetheless, even more men likely could have chosen to forego radiation and/or surgery. The authors are quick to point out that every patient must make an individual decision about treatment based on specific medical and personal facts and values.
This study has several limitations. First, the majority of evidence on the benefits of watchful waiting was published from 2004-2006, but this study evaluated treatment from 2000-2002. It is possible that prostate cancer treatment trends have changed in light of the recent research. Also, limitations in the database used to identify patients made it impossible to accurately distinguish between low- and moderate- risk patients over age 70. There may have been some misclassification in this group, leading to an overestimate of the number of men ages 70-74 for whom watchful waiting was the best choice.
Finally, the authors recognize that patients should always have the right to make their own informed decision about whether a treatment is overtreatment. The diagnosis of cancer is an emotional experience, and many people given information about watchful waiting will nonetheless want all possible anticancer steps taken–whatever the consequences to their quality of life (or insurance providers)–and even if treatment cannot guarantee longer survival.
How Does This Affect You?
These findings suggest than many men with lower risk prostate cancers are being treated with surgery or radiation, when mounting evidence indicates that watchful waiting may be a reasonable treatment option for some. As the authors point out, many people who start with watchful waiting eventually choose more active interventions either because their tumor progresses or because they find themselves more uncomfortable with their initial decision. But for those who choose watchful waiting, outcomes can actually be better, since treatment for prostate cancer can lead to complications, including ]]>erectile dysfunction]]> , ]]>urinary incontinence]]> , and bowel difficulties. Even hormonal treatments (the least invasive of all) can have significant effects on physical health and quality of life.
If you are diagnosed with prostate cancer, and especially if you are over age 65-70, ask your doctor if watchful waiting is an option for you. Since prostate cancer often spreads very slowly, it may never cause problems during the remaining years of your life, may never need to be treated, and might never even have been diagnosed during your lifetime without the highly sensitive screening technologies used today. Delaying treatment can help you and your doctor to betterdetermine if the benefits of treating your cancer outweigh the risks.
American Cancer Society
National Cancer Institute
Miller DC, Gruber SB, Hollenbeck BK, et al. Incidence of initial local therapy among men with lower risk prostate cancer in the United States J Natl Cancer Inst . 2006;98(16):1134-1141.
Last reviewed August 2006 by ]]>Lawrence Frisch, MD, MPH]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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