Most Common Prostate Cancer Treatment May Not Always Be Best

Prostate cancer treatment with radiation therapy was more common than surgery or active surveillance

(RxWiki News) The majority of prostate cancer patients may receive the same treatment. There are other options, however, and they may be underused.

A new study found that radiation therapy was the most commonly used treatment among older prostate cancer patients. Radiation therapy may come with side effects, and, in some cases, less aggressive treatments may work instead.

Prostate cancer is the most common type of cancer among American men, according to the American Cancer Society (ACS). Treatment can involve methods like radiation therapy or prostatectomy, in which the prostate is surgically removed.

"These men may experience considerable detriments of quality of life owing to sexual, urinary, and/or rectal toxic effects associated with these treatments," wrote the authors of this new study, led by Jim C. Hu, MD, of the David Geffen School of Medicine at the University of California, Los Angeles.

The ACS notes that prostate cancer can sometimes grow very slowly and may never require treatment. In these cases, an "active surveillance" method may be used, in which the doctor and patient monitor the cancer to see if it advances and requires further treatment. This is also sometimes called "watchful waiting."

As the ACS pointed out, there are risks and benefits for every treatment type. In watchful waiting, one risk is that the disease might be given the chance to grow and spread. Some men might not be comfortable with this method.

According to Dr. Hu and team, past research has found that many patients and their doctors were opting for more aggressive treatments over watchful waiting or active surveillance.

These researchers wanted to explore what treatments prostate cancer patients were opting for. To do so, they used National Cancer Institute and Medicare data to identify more than 37,000 men with prostate cancer. All the men were 65 or older.

These men were all diagnosed between 2004 and 2007 and were followed until the end of 2009. The type of treatment they received was recorded.

Dr. Hu and team found that, overall, the most common treatment for prostate cancer was radiation therapy — 57.9 percent of the patients received this treatment.

Radical prostatectomy was the next most common treatment type, used by 19.1 percent of the patients. Only 9.6 percent of the patients used watchful waiting or active surveillance.

Dr. Hu and team noted that radiation therapy rates appeared to be increasing. These researchers suggested that active surveillance may be underused. They stressed, however, that further research is needed to understand why patients and doctors choose certain treatment methods.

In an editorial about this study, Charles L. Bennett, MD, PhD, of the South Carolina College of Pharmacy in Columbia, and team also stressed that more research into this complicated issue is needed.

One issue Dr. Bennett and team highlighted was that, though grouped together in this study, active surveillance and watchful waiting may be considered two different treatment plans.

The ACS explained that, in some cases, active surveillance may involve more tests, exams and screenings, while watchful waiting might imply the use of fewer tests and a greater reliance on the patient's symptoms.

Dr. Bennett and team noted that while more studies that explore the usage of different treatments are needed, so are studies exploring the effectiveness of these treatments.

Deciding which treatment is correct for individual cases of prostate cancer is a complicated issue. Patients should have detailed discussions with their doctors to help find the best approach for their case.

The study and editorial were published online Feb. 19 in JAMA Oncology.

The National Institutes of Health and the Department of Defense funded this research. Dr. Hu and team disclosed no conflicts of interest.

Review Date: 
February 18, 2015