Prostate Cancer Treatment Decisions Reviewed

One of the largest studies of its kind concludes that most older men with early prostate cancer do not shorten their survival odds if they adopt a "wait-and-see" approach to the disease.

In fact, most such patients will die of other causes or they simply will not develop any complications from the cancer, says a report presented at the 2008 Genitourinary Cancers Symposium.

"Many elderly men with lower risk cancer may do well with conservative management," concludes study author Grace Lu-Yau, at the Cancer Institute of New Jersey.

"Each patient facing a treatment decision has to ask himself what is the potential survival benefit of various treatments and the potential side effects of various treatments," says Lu-Yau.

She says patients should then compare this potential risk of side effects with the potential risk of cancer complications if the cancer is left untreated - and ask themselves which treatment option is their personal preference.

Localized Cancer May Be Left Untreated

The question of whether to treat or not treat prostate cancer has long absorbed experts.

Although one in six men in the US will be diagnosed with prostate cancer in their lifetime, many of the malignancies are slow-growing, and there is currently no reliable way to identify which men will benefit from treatment.

Better knowledge of the natural history of the disease (i.e., what happens without any treatment) would help guide treatment decisions, explains Lu-Yau.

This study is one of the first to look at the natural history of prostate cancer since PSA (prostate-specific antigen) blood testing has become commonplace. PSA tests can detect a prostate cancer six to 13 years earlier than previous methods.

Lu-Yau and her colleagues looked at data on more than 9,000 men with Stage I or II prostate cancer diagnosed between 1992 and 2002 who did not undergo treatment. The mean age of participants was 77 years.

Seventy-two percent of these men died of other causes or didn't have enough cancer progression to warrant surgery or radiation, the researchers found. For the remaining 2,675 men who did receive treatment, the median time between diagnosis and start of therapy was more than 10 years.

Not surprisingly, men with less aggressive disease survived longer than those with more aggressive tumors.

"For elderly men with localized prostate cancer, the potential survival benefit for treatment is most likely modest, therefore it is very critical to weigh the risk of having side effects of various treatments with the risk of developing cancer-related complications down the road," says Lu-Yau.

"The majority of patients will die of other causes or remain alive without significant major complications," she says.

Radiation after Cancer Recurs May Help

A second study presented at the conference found that giving salvage radiation therapy (SRT) to men whose PSA levels rise after having their prostate removed can reduce their risk of dying from the cancer by more than 60 percent.

SRT is typically given only after a recurrence, not after an initial diagnosis of prostate cancer, notes study lead author Dr. Bruce Trock, at Johns Hopkins University School of Medicine.

Existing studies have either not been large enough or long enough in duration to determine if SRT prolongs survival.

In this retrospective analysis of 635 men who had experienced a recurrence after having their prostate removed, 62 percent of those who did not receive any salvage therapy were still alive after 10 years, versus 86 percent of those who received SRT and 82 percent of those who received SRT plus hormone therapy.

Men whose PSA doubling time (the amount of time it took for PSA levels to double from when in first becomes detectable) was six months or less had the greatest benefit.

"If another study was able to replicate our data, it could lead to clinical trial that would eventually support a way to determine who should get immediate adjuvant radiation and who could wait until the time of recurrence to have SRT," Dr. Trock says.

"The question is, could a benefit be achieved in some of these men if you waited to see whether they recurred or not?" he asks.

Always consult your physician for more information.

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Online Resources

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American Cancer Society

National Cancer Institute (NCI)

National Prostate Cancer Coalition

NIH - Prostate Cancer

Prostate Cancer Foundation

Coping with Prostate Cancer

Every person is different, and not all men have the same experience, thoughts, or feelings.

However, some common feelings and concerns may be present when a man is diagnosed with prostate cancer, including the following:

threatened masculinity
The prostate gland is critical to a man's sexual function; the possibility and actual diagnosis of prostate cancer can instill fear and anxiety for patients since it threatens their masculinity.

They fear they will never be a "real man" again in terms of sexual performance. Rather than adopting a course of action in response to these fears, consider educating yourself so that you can make the best health decisions possible.

Treatment considerations vary, as do their effects on sexual function. It is normal to be scared, angry, or depressed when given this diagnosis. The good news is that prostate cancer is very treatable.

feeling embarrassed or avoiding discussions about the diagnosis
Each patient, together with their partner or family, should try their best to communicate about the diagnosis of prostate cancer, how it makes them feel, what their expectations are, what their fears are, etc.

Prostate cancer affects not only the patient, but also those closest to them. Arm yourself and those around you with information and take the time to learn about your cancer diagnosis, the risks and benefits of various therapies, and the impact they may have on your life.

Take the time for you and those you love to become informed.

being honest with yourself and with your physician
Sometimes, men are embarrassed or feel guilty for ignoring possible signs of prostate cancer, or avoiding visits with their physician due to the nature of a prostate examination.

Other times, men avoid going back to see their physician once the diagnosis of prostate cancer is made, choosing instead to treat themselves with alternative medicines, or simply deny the diagnosis of cancer altogether.

It is your responsibility to be honest with yourself and your healthcare provider, in order to form a partnership with your physician that is based on candid, honest dialogue, to ensure the best care possible.

It is normal to consider a second opinion and investigate all of the care options available to you, until you have made the best choice for yourself.

Be assured that physicians understand getting a second opinion to confirm the diagnosis, or to provide a different perspective on treatment options. Above all, become an advocate for your personal healthcare.

being afraid to ask for help
It is normal to feel helpless, alone, or isolated when you have been diagnosed with prostate cancer.

Consider going to a support group. You will find numerous other men who understand your situation because they have been there themselves. Bring your partner or a friend as a support person, if you choose.

You will be amazed at how much information you can gain from those who have "been there" and by the amount of stress eliminated in the knowledge that others truly do understand. Ask your physician where the prostate cancer support groups are in your area.

Always consult your physician for more information.