Okay to Go Slow with Prostate Cancer

Prostate cancer that is localized can be observed

(RxWiki News) If you've been following the news about prostate cancer, you know a great deal of caution has been injected into the conversation. A new study shows that a conservative approach to the disease is quite valid.

Men with localized prostate cancer live essentially as long being observed as those who have had their prostates surgically removed. 

"Talk to your doctor about cancer screenings."

Since PSA (prostate specific antigen) testing started being used, no study has definitively looked at the difference in lifespan between men who received surgery called a radical prostatectomy and those who were simply observed.

Timothy Wilt, MD, MPH, core investigator at the Veteran Affairs Center for Chronic Disease Outcomes Research, led the study.

A total of 731 men, with a median age of 67 and a median PSA value of 7.8 ng per milliliter were involved in the study. Participants were randomly assigned to have either a radical prostatectomy or be observed. 

Researchers were looking at how these men eventually died - whether specifically from prostate cancer or from any other cause (all-cause mortality)

Here's what they learned after following these men for a median of 10 years:

  • 171 of the 364 (47 percent) of those who received surgery died.
  • 183 or 367 (49 percent) of men who were observed died.
  • This means that surgery provided a 2.9 percent lower absolute risk of dying.
  • Prostate cancer or its treatment caused the deaths of 21 men who received surgery and 31 men who were observed.
  • This means surgery provided a 2.6 percent lower risk of dying.
  • Surgery was related to lower all-cause mortality among men with PSA values greater than 10, and possibly among men with intermediate- or high-risk tumors.
  • Of the men who had surgery, 21.4 percent had adverse events within 30 days of the operation, including one death.

The authors concluded that "as compared with observation, radical prostatectomy did not significantly reduce all-cause or prostate cancer mortality through at least 12 years among men with clinically localized prostate cancer that had been diagnosed in the era of PSA testing. Absolute differences in mortality between the study groups were less than 3 percentage points."

Prostate cancer expert, E. David Crawford, MD, applauded the efforts of Dr. Witt and his team for conducting one of the few randomized clinical trials on localized prostate.

"Unfortunately their message does not resonate with many practitioners," said Dr. Crawford,  head of the Section of Urologic Oncology at the University of Colorado Health Sciences Center in Denver.

"The take home message is that we do over-treat a lot of men to improve the outcome of a few. I believe that the we must have better markers to help us define who benefits from treatment," said Dr. Crawford, who is also professor of surgery, urology and radiation oncology at UCHS.

In an accompanying editorial, Ian M. Thompson, Jr., MD, and Catherine M. Tangen, DrPH, from The University of Texas Health Science Center at San Antonio, and the Fred Hutchinson Cancer Research Center in Seattle, write, "What is a rational approach to control this disease? The most efficient solution will probably include biopsy only for men with lethal cancer, treatment focused on this type of cancer, and individualized treatment approaches."

This research was published July 19 in The New England Journal of Medicine.

The research was supported by grants from the Department of Veterans Affairs Cooperative Studies Program, the National Cancer Institute and the Agency for Healthcare Research and Quality.

Several of the authors have financial relationships with pharmaceutical and other healthcare companies.

Review Date: 
July 19, 2012