d not require treatment. The diagnosis of a disease in patients where that disease will never cause symptoms is called over−diagnosis.
The death rate due to prostate cancer has also fallen since the introduction of PSA screening. How much of this is due to the screening? The authors estimate that if the entire decrease in the death rate was due to PSA screening—which is highly unlikely—over 20 men were diagnosed with prostate cancer for every life saved. Since around 80% of those diagnosed sought treatment, roughly 15 of every 20 men whose prostate cancer was found because they were screened for PSA sought treatment needlessly.
The Risks for Men Over 65
The second study, published in the September 16 issue of the Journal of the American Medical Association, focused on elderly men. Grace L. Lu−Yao headed the study, which looked at the survival rate of men who elected not to treat their prostate cancer with radiation or surgery for at least six months in the post−PSA era and compared this to the rate in the pre−PSA era. The men in this study were all over 65 at the time of diagnosis; their average age was 78. The study found that men who elected this conservative treatment are doing much better now than they did in the past.
Liu−Yao suggests that this should cause physicians and their patients to reconsider conservative treatment, particularly in light of earlier studies suggesting little if any benefit from more aggressive treatment. Liu−Yao stresses that the information in her study applies only to those over 65 at the time of diagnosis; the results should not be applied to younger men.
In the third study, published in the August 31 issue of the Journal of Clinical Oncology, a team that included Martin G. Sanda sought to examine the consequences of choosing deferred treatment after a diagnosis of prostate cancer. The men in this study were an average age of 60 at the time of their cancer diagnosis. Using data on 51,529 men from the Health Professionals Follow−up Study (HPFS), the team found no statistical difference in the death rates due to cancer of those who elected treatment within one year and those who did not. Only 1% of those who elected immediate treatment and 2% of those who didn't eventually died of their cancer. While this difference is twofold, it involves such a small total number of men that it's statistically no difference at all. It's similar to the difference between finding a penny inside of your couch and finding two pennies. The difference is only a single penny.
HPFS began in 1986 and is ongoing. It collects detailed medical information on a variety of topics and is not specifically about prostate cancer. Information is updated by questionnaire every two years. At some point during the study, 3,331 men were diagnosed with prostate cancer. Only 342 of these men—just over 10%—opted to defer treatment for a year or more.
Most of the men who elected to defer treatment had been diagnosed with low−risk tumors or were elderly; none were under 50. At the study's end, half of them still had not undergone any treatment. And they were doing fine. On average, this was 7.7 years after their cancer had been diagnosed.
Sanda notes that this is a compelling reason for men with low−risk tumors to consider watchful waiting as a treatment option.
These three studies all suggest that more men should consider treating their prostate cancer with watchful waiting. There's still much disagreement among doctors about who is and isn't an appropriate candidate. Each case of prostate cancer has to be assessed individually.
To anyone who has recently received a diagnosis of prostate cancer, deciding on an appropriate course of treatment is not easy. There's too much information and too much uncertainty. Fortunately, with prostate cancer, an immediate decision on treatment is rarely necessary. There's usually time to think the matter out. One place to get an overview of the many issues involved is at the National Cancer Institute's website. There's a prostate cancer summary available, as well as detailed information on many pros