Prostate Cancer Treatment Benefits
Debated
The latest update from a European study
that has followed men with prostate cancer for more than a
decade leaves the debate about the advantages of aggressive
treatment versus "watchful waiting" undecided.
The findings were published in the
Journal of the National Cancer
Institute.
The advantage in survival seen for men
who underwent surgery to remove the prostate gland
disappeared after 10 years.
While deaths attributed to cancer
continued to be lower among those having surgery, the
overall death rate for both groups was the same, according
to the researchers with the Scandinavian Prostate Cancer
Group.
The meaning of the study for men now
being diagnosed with prostate cancer is uncertain, because
the study began before the use of testing for
prostate-specific antigen (PSA), today's primary method of
diagnosis, the researchers add.
"In settings with a large proportion of
PSA-detected tumors, the relative reduction in risk of death
following radical prostatectomy [removal of the gland] might
be somewhat larger or similar to that in our study, but the
absolute reduction would be smaller," they say.
Dr. Yu-Ning Wong, at Fox Chase Cancer
Center in Philadelphia, says it is "unclear how these
results apply to the patients we are taking care of today.
They show how many questions remain unanswered."
Dr. Wong led a previous study that
found an apparent benefit in survival for men who had
aggressive surgical treatment of early prostate cancer. But
it was not a randomized, controlled trial - the gold
standard for medical research.
"Basically, I don't think we know the
right answer about what to do," she says.
Prostate cancer is diagnosed in about
one of every six American men. There is currently no way to
distinguish between a cancer that will grow so slowly that
it poses little danger to life from one that can grow
aggressively enough to be fatal.
A common medical saying is that "more
men die with their prostate cancer than of it."
Uncertainty about prostate cancer
treatment has led to a new federal recommendation that men
over 75 should not have PSA tests because the risks of
treatment outweigh the benefits.
A final answer about whether surgery
and other aggressive treatment is preferable to merely
watching the course of the disease will not come for years,
says Dr. Wong.
A controlled trial is under way in
Europe, and one is planned for the US, she says.
Meanwhile, the decision about treatment
versus watchful waiting must be made for each individual,
explains Dr. Wong.
"I have discussions with a patient
about his other medical conditions, his age, his willingness
to receive treatment that may have long-term side effects,
weighed against the risk that he may develop an aggressive
cancer," she says.
Stephen Zeliadt, Ph.D., a research
scientist at the Fred Hutchinson Cancer Research Center in
Seattle, says the new study "does provide evidence that
intervention in the form of surgery does have a curative
effect for some men. The question is, which men?"
Another question is whether the study
results apply to "a screening population" of men who have
PSA tests, notes Dr. Zeliadt. "With screening, you catch a
lot of different types of cancer, and also at different
ages. There is no information in the study on the age of
detection."
So, Dr. Zeliadt adds, this study does
not help solve the prostate cancer riddle.
"It probably makes it even more
confusing," he says.
Dr. Peter T. Scardino, at Memorial
Sloan-Kettering Cancer Center in New York City, says the
study did offer an important finding: "The big benefit of
treating potentially lethal prostate cancer comes early, in
the first five to 10 years."
The study also "showed lots of benefits
of surgery but did not find any benefit from surgery for men
over the age of 65," he says.
Always consult your physician for more
information.
(Our Organization is not responsible for the content of
Internet sites.)
American
Academy of Dermatology
Archives of Dermatology – Standardizing the 60-Second Hair Count
CDC
- Men's Health
Men's Health Network
National
Institutes of Health (NIH)
National Women's Health Information Center - Men's Health