When it comes to treating prostate cancer, there are no certainties, only statistics. And the statistics from three recent studies indicate that men newly diagnosed with prostate cancer should at least consider whether immediate treatment is necessary.
This is especially true for older men and men diagnosed with the lowest risk tumors.
Three recent studies have prompted a reassessment of the ways in which prostate cancer is diagnosed and treated as well as who should be treated. One study found that over one million men diagnosed with prostate cancer in the last twenty years had cancers which ultimately caused few or no symptoms. The second study found that, since 1992, elderly men who elected conservative treatment of their prostate cancer had a much higher survival rate than in earlier eras and were six to seven times more likely to die from causes other than their cancer. Finally, a third study found that men who elected to defer treatment for their prostate cancer were faring nearly as well eight years later as those who elected immediate treatment.
[M]en who elected to defer treatment for their prostate cancer fared nearly as well eight years later as those who elected immediate treatment.
"Watchful waiting" is continuing to monitor the cancer for signs of progression without treating it by radiation, surgery, hormones or other method. Although there is a risk that the cancer will progress and become clinically active disease which might have been cured when the cancer was initially found, on the other hand, the patient has avoided the undesirable effects of these treatments and may outlive any risk from the cancer itself. And if the cancer starts changing, so can the treatment.
Risks and Classifications of Prostate Cancer
The danger from prostate cancer is that it will spread from the prostate to other parts of the body. Yet unlike most other cancers, prostate cancer usually spreads slowly and spreads even more slowly the older a man is. Around 85% of all prostate cancers are localized: confined to the prostate gland when diagnosed. Many of these are small tumors which will remain in the prostate gland for the entire life of the patient.
Prostate cancers are classed as low−risk or high−risk based on three factors: the size of the tumor, whether it is confined to the prostate gland and its microscopic appearance (the lowest risk tumors are not that different in appearance from normal prostate tissue; these are called well−differentiated tumors). The lowest risk tumors are small, well−differentiated tumors which are confined to the prostate gland.
The problem in selecting a treatment comes from the fact that a small number of these low−risk tumors will spread to other parts of the body fairly quickly and doctors are unable to tell which ones will do this. Whether the odds of this happening are one in fifty or one in a million, nobody wants to be the one. And treatment is usually selected as if the patient will be that one.
The PSA Screening Test
In 1987, a screening test for prostate stimulatory antigen (PSA) was introduced. A high PSA reading is not a diagnosis of prostate cancer; it is merely an indication that a person may have prostate cancer. Diagnosis of prostate cancer requires further testing, usually a biopsy. Since the advent of PSA screening, more cases of prostate cancer are being detected and these cancers are being found at an earlier stage; many would never have been found at all if the PSA test had not been given. And detection of prostate tumors that will never cause any symptoms is virtually useless information.
In the first study, published in the October 7 issue of the Journal of the National Cancer Institute, H. Gilbert Welch and Peter C. Albertsen found that since the introduction of PSA screening, 1.3 million men were diagnosed with and over one million treated for prostate cancers that would have gone undetected without PSA screening. The fact that these cancers would never have been diagnosed indicates that most of them caused no symptoms in their patients. This suggests that these cancers di