Some Prostate Cancers Don't Need to be Treated

Close monitoring may be safer than surgery and radiation in older men

(RxWiki News) Men aged 65 and older who are diagnosed with a low-risk form of prostate cancer don't need to jump right into treatment. Delaying surgery and radiation doesn't pose added risk of death as long as the cancer is closely monitored.

Those are the findings of a Johns Hopkins study, believed to be the largest and longest study of men initially diagnosed with a slow-growing, very non-aggressive form of prostate cancer.

“This study offers the most conclusive evidence to date that active surveillance may be the preferred option for the vast majority of older men diagnosed with a very low-grade or small-volume form of prostate cancer,” says study senior investigator and urologist H. Ballentine Carter, M.D. “These are men with a favorable risk disease profile to begin with.”

"Older men with slow-growing prostate cancer don't need immediate treatment."

The study, which followed hundreds of men for as long as 15 years, found that men with very low risk prostate cancer in its earliest stage stand very little chance of dying from the disease.

“The vast majority of these men are ideal candidates for active surveillance because they are older and are able to avoid the risks and complications associated with surgery and radiation, Dr. Carter says. “Our findings really underscore the need to address excessive treatment of this milder stage of the disease in older men, especially seniors,” he added.

Possible complications from surgery or radiation to treat tumors, he says, include incontinence and other bowel, urinary or sexual problems.

In Depth

  • A total of 769 men were enrolled in the study from 1995 through 2010, and are being monitored through semiannual check-ups and a yearly biopsy.
  • All study participants, 90 percent white and 6 percent black, met the key criteria of having a prostate-cancer Gleason score of 6 or less. The score is used to rate the severity of the disease. Higher scores, typically from 7  through 10, suggest a more aggressive form of the disease that in most cases would require treatment.
  • Men who strictly met all study criteria for very low-risk disease were 30 percent less likely to be reclassified to a high-risk category during surveillance and need subsequent surgery or radiation than men who did not meet one or more study criteria.
  • Eighty percent of men involved in the latest analysis met at least one or more other study criteria for small-volume tumors. These included the amount of cancer found on biopsy of the prostate gland, plus a ratio of blood levels of a protein linked to the cancer, called prostate-specific antigen (PSA) to gland size, or PSA density. Fewer than three biopsy cores could have cancer, with the disease present in no more than half of any core. Most study participants had a PSA density of less than 15 percent.

Current guidelines endorsed by the National Comprehensive Cancer Network, Dr. Carter says, could be broadened as a result of the study and already list active surveillance as a preferred course of action for many older men, especially seniors.

According to the American Cancer Society, prostate cancer is the most common cancer in American men other than skin cancer. Latest statistics estimated nearly 218,000 new cases of prostate cancer for 2010 and 32,050 deaths from the disease. There are more than 2 million prostate cancer survivors in the United States.

Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer.

Review Date: 
April 21, 2011