Low-risk prostate cancer often overtreated

NEW YORK (Reuters Health) – Approximately one half of men
diagnosed with low-risk prostate cancer undergo surgery or
radiation therapy when “watchful waiting” may be more
appropriate, according to a research team at the University of
Michigan in Ann Arbor.

Recent studies have shown that watchful waiting or
“expectant management” — regular checkups to see if treatment
is necessary — is a valid option for men with early-stage
prostate cancer, Dr. John T. Wei and his associates note in
their article in the Journal of the National Cancer Institute.

“Just as a failure to treat a potentially lethal prostate
cancer is generally considered inappropriate from a
quality-of-care perspective,” they continue, “aggressive
treatment of indolent cancers (i.e., overtreatment) may also
reflect suboptimal care in that it confers risk to patients and
increases costs without providing health benefits.”

Wei’s team evaluated information in national databases to
identify 71,602 men diagnosed with localized or regional cancer
of the prostate between January 2000 and December 2002.

The risk to the patients from their cancers was based on
how well differentiated the tumor was; that is, how clearly
defined it was, rather than spread-out with indistinct
boundaries.

A “lower risk” prostate cancer group was classified as “men
of any age at diagnosis with well-differentiated tumors or men
70 years or older at diagnosis with moderately differentiated
tumors.”

Approximately a third of subjects (24,825) were classified
as having lower risk cancer. They were good candidates for a
watchful waiting approach, but in fact 55 percent underwent
immediate treatment — 45 percent received radiation therapy
and 10 percent underwent surgical removal of the prostate —
which equated to overtreatment.

Wei’s team emphasizes that “initial expectant management
need not be a permanent treatment choice, and that some men,
particularly younger patients, should eventually proceed to
appropriate curative therapy after a period of asymptomatic
expectant management.”

They therefore recommend “active surveillance with delayed
intervention ” as “an appealing approach to addressing
overtreatment concerns among men with lower-risk prostate
cancer.”

SOURCE: Journal of the National Cancer Institute, August
16, 2006.