For older men with low-risk prostate cancer, a new study adds to evidence that closely watching the tumor instead of immediately treating it may be a reasonable option.
In a study of more than 650 men who averaged 66 years old, most were able to go for 5 years without treatment for their prostate cancer, according to the report in the Journal of Clinical Oncology.
"The underlying problem is that we're over-treating prostate cancer because we don't have a perfect method of identifying those people that will never be harmed by their cancer," said Dr. H. Ballentine Carter, professor of urology and oncology at Johns Hopkins University School of Medicine in Baltimore, Maryland.
"In general, the vast number of (prostate) cancers are of the slow-growing variety that a person could live with for years," Carter, who co-authored the study, told Reuters Health.
Prostate cancer screening through PSA (prostate-specific antigen) testing has helped find cancers that never would have caused problems, said Dr. Otis Brawley, chief medical officer of the American Cancer Society, who was not part of the study.
A PSA test costs about $20 to $30, Carter said.
The ease of using the test to screen men has led to growing concern that low-risk cancers are being overdiagnosed, particularly in older men more likely to die of some other cause before the prostate cancer ever becomes an issue.
Past studies have shown that prostate cancer screening doesn't help men live longer, and not treating the disease doesn't result in high death rates. (See Reuters Health stories of June 18 and September 15, 2010.)
Based on these and other findings, the U.S. Preventative Services Task Force does not recommend screening men older than 75, and says there isn't enough evidence of whether it's useful for younger men.
For those men over 65 who are tested and diagnosed with a low-risk prostate cancer, "the first question is not how I'm going to treat, but if I'm going to treat or not," Carter said.
Ultimately, about a third of the men in the study had treatment. The majority -- about 8 out of 10 -- put it off for 2 years, while 6 out of 10 went for 5 years. There were no deaths from prostate cancer in the study.
The researchers used active surveillance, which means checking PSA levels and yearly biopsies. In this approach, if the tumor is found to have progressed, a man will then undergo treatment involving either surgery or radiation.
These treatments can lead to urinary or bowel incontinence and erectile dysfunction. Most men will have one or more of these side effects, but many lessen over time, according to the Prostate Cancer Foundation.
Surgery runs from $20,000 to $30,000, while radiation treatment can cost from $20,000 to $100,000, depending on the type, Brawley said.
The researchers followed more than 650 men, averaging 66 years old, who had been diagnosed with very low-risk prostate cancer. They followed the men for as long as 15 years. At the end of the study, about 400 of the participants had had no treatment for their cancers, and about 250 did.
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