March 14, 2006

Delaying therapy OK for low-risk prostate cancer

By Amy Norton

NEW YORK (Reuters Health) - Men with early, slow-growing
prostate cancer may safely wait up to six months before
starting treatment, a new study suggests.

Researchers found that among 895 men with so-called
low-risk prostate cancer, those who waited up to six months
before undergoing surgery to remove the prostate had no
increased risk of disease recurrence. There was, however,
evidence that men who waited longer than six months were more
likely to show "biological progression," a marker of possible
cancer recurrence.

Because this group included a relatively small number of
men -- and because it's unclear why they delayed therapy --
it's too soon to draw conclusions about the finding, according
to the study's lead author.

"It's concerning, and it needs to be confirmed in further
studies," said Dr. Stephen J. Freedland of Duke University
Medical Center in Durham, North Carolina.

For now, he told Reuters Health, the overall findings
should reassure men with low-risk prostate cancer that they
don't have to rush into a treatment decision after they're

"Take some time, understand the treatment options,"
Freedland said.

The issue of prostate cancer treatment is still
controversial. Because the disease is often slow-growing, one
of the options is "watchful waiting" -- delaying treatment and
instead monitoring patients for signs of progression. The point
is to spare men the side effects of treatments like surgery,
radiation and hormone therapy.

For men who are elderly and have other serious health
problems, the risks of prostate cancer treatment may outweigh
the benefits. But it has not been clear whether watchful
waiting -- or just a delay in choosing a treatment -- might dim
the prognosis of men with low-risk cancer.

The current findings, Freedland said, support the belief
that postponing therapy is a "reasonable option" for them.

The study, published in the Journal of Urology, included
895 men with low-risk prostate cancer who underwent surgery
between 1988 and 2004. Three-quarters had their prostate glands
removed within three months of diagnosis, while most of the
remaining men had surgery within six months.

Men in the latter group, the researchers found, were not at
greater risk of biological progression after their surgery.

The same was not true of the small number of men who waited
more than six months to have surgery. They were two to three
times more likely than men who had surgery within three months
to develop signs of cancer recurrence, the study found.

Still, Freedland said he is "not convinced" that the longer
treatment delays themselves are responsible for the finding.
More studies, he said, are needed to answer this question.

SOURCE: Journal of Urology, March 2006.