The treatment may be worse than the disease itself in a growing percentage of men diagnosed with prostate cancer, so there is an "urgent need" for more research into the role of delaying treatment or avoiding it altogether, a panel of experts convened by the National Institutes of Health concluded Wednesday.
Next to skin cancer, prostate cancer is the most common cancer in U.S. men. This year, more than 240,000 are expected to be diagnosed, and 33,000 are expected to die from it. Surgery or radiation can cure prostate cancer, but the treatments leave many men with erectile dysfunction and/or urinary incontinence.
Before PSA screening was introduced in 1987, most prostate cancers were detected at a more advanced stage. Men either had symptoms from advanced disease or their doctor felt a growth in the gland during a rectal exam.
But PSA screening, a blood test done routinely in men 50 and older, has increased detection of low-risk prostate tumors that are unlikely to be fatal.
Today, many men with no symptoms are being diagnosed with these slow-growing tumors, says panel chairwoman Patricia Ganz, director of prevention and control research at University of California-Los Angeles' Jonsson Comprehensive Cancer Center.
More than half of prostate cancers diagnosed today are low-risk, panelists say; 20-year follow-ups show that only 5% of men with low-risk prostate cancer die of it. "These are tumors that probably never would have been discovered" in the man's lifetime, Ganz says.
Low-risk cancers probably shouldn't even be called cancer, say panelists. "Strong consideration should be given to removing the anxiety-provoking term" for this condition, they say. Yet cancer is a scary word, spurring more than 90% of men with low-risk prostate cancer to choose to be treated immediately, they add. The rest opt for an "observational strategy."
There are two main observational approaches: "active surveillance," delaying treatment until there are signs the disease has progressed, and "watchful waiting," forgoing treatment to cure the disease and, instead, using therapy only to relieve symptoms when they arise.
To examine why few candidates opt for active surveillance, researchers at Georgetown University in Washington and Kaiser Permanente in Northern California in September began enrolling 1,500 newly diagnosed low-risk cancer patients into an NIH-funded study.
"Not all cancers are created equal," notes Kathryn Taylor of Georgetown, who is co-directing the study. "Some are deadly, but in the case of prostate cancer, many are not." That's difficult for many Americans to grasp. "In this culture the message has been received loud and clear that early detection and early treatment is what you do for cancer."
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