Prostate Cancer: To Treat or Not to Treat

Prostate cancer is the most common cancer in men. Approximately 250,000 men each year are informed that they have been diagnosed with the disease. Despite being the most common, prostate cancer is not the deadliest. Cancers of the lung and digestive tract take the lives of more men than that of the prostate. Only about 30,000 men die from prostate cancer each year, while nearly 1,000,000 men have the disease.

This paradox presents quite a dilemma for patient’s who are trying to determine what course of treatment they would prefer. A textbook that I have on my bookshelf details the problem. “The goal of management is to eradicate the disease. However, as noted, in many patients prostate cancer has no adverse impact upon the quality or length of life, and in these cases treatment is an unnecessary and potentially a source of significant morbidity [i.e. loss of function such as impotence and incontinence]. Even the ability of treatment to increase survival has not been conclusively proved… Probably the best policy is to offer treatment to any patient whose potential survival exceeds the potential for the tumor to shorten that survival.” In other words, for many men, the treatment is worse than the disease. So how does one determine whether or not to treat and which treatment to choose?

Two recent long-term studies may help to clarify the decision-making. The first study was conducted at Sweden, where 695 men with early prostate cancer were recruited and followed from 1989 to 1999. All of the men who enrolled in this study were less than 75 years of age and expected to live at least 10 more years. In addition, the patients in this study had tumors that were large enough for the doctor to feel. They were randomly assigned to either receive surgical resection of their prostate or to simply observe and not treat.

After 10 years, 10% of the men who had had surgery had died from prostate cancer, while 15% of those who did not receive treatment lost their lives from prostate cancer during that same timeframe. The authors pointed out that, while the risk of death was not substantially less for those that opted for surgery, it did reduce the risk of cancer spreading (metastasis).

A second study was conducted at the University of Connecticut. In this study, records from the Connecticut Tumor Registry were reviewed in the retrospective fashion to look at what happened with 767 men who were diagnosed with prostate cancer between 1971 and 1984. These patients were either simply observed or given treatment to reduce the ability of their male hormones to stimulate the cancer (“androgen withdrawal therapy”). All of the men were between the ages of 55 and 74 when they were diagnosed. The purpose of this study was to compare the outcomes of these two treatment options while following survival rates for 20 years.

The researchers discovered that survival depended on the aggressiveness of the type of prostate cancer. Men who had low-grade prostate cancers had a minimal risk of dying from it over the course of the following 20 years. This would apply to men who had been told that their Gleason score was between 2 and 4. On the other hand, men who had high grade or aggressive prostate cancers (identified as a Gleason score of 8 to 10), experienced mortality from prostate cancer at a rate of 20-fold higher than those that were low grade.

The authors concluded that mortality rate from prostate cancer was very stable and that aggressive treatment was not appropriate for those who have localized low-grade prostate cancer.

Here are the take home points. 1. You should especially consider more aggressive treatment if you are diagnosed with prostate cancer at a relatively young age (in other words you have a significant life expectancy ahead of you), and perhaps if your cancer is either palpable (i.e., able to be felt by the physician) on examination and/or biopsy results show that it is an aggressive tumor. 2. If you are an older individual, especially older than the age of 75, you may do better with no treatment. 3. If your prostate cancer is detectable only by PSA or other testing, but is not palpable, you might consider watchful waiting, again particularly if the tumor is not considered aggressive.

(Citation: Genitourinary cancer, by Bruce A. Lowe, M.D. of Oregon Health Sciences University. On page 655 of Conn’s Current Therapy 1995, edited by Robert E. Rakel, M.D.)

Harder, Ben (2005). “Watch and Wait, or Not: Studies Weigh Risks of Delaying Prostate Surgery.” Science News. 167 (20): 309.

Posted on 12/12/2006 under Christian Health & Medicine, Diseases. Comments RSS feed.
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