Whether or not to treat prostate cancer conventionally is one of the major medical dilemmas we have today. Prostate cancer is the most common cancer in American men. Approximately 222,000 cases will be diagnosed this year, however most prostate tumors tend to grow slowly. They never actually threaten lives. There is no sure way to tell which tumors will grow at a more rapid rate.
Prostate Specific Antigen (PSA) tests can help find tumors many years before they cause any prostate cancer symptoms, however routine screening of men who are at average risk is currently not recommended, because there is no proof that it saves lives.
Prostate cancer treatments are particularly rugged, especially on older men. And many men end up after the treatment with sexual, bladder control or other prostate gland or prostate health problems. Many doctors instead recommend "watchful waiting" to monitor signs of prostate disease and treat it only if the signs or symptoms get worse. Smaller studies have given contrary views of the safety of this approach.
This new study looked at the natural course of the disease in the men who had chosen that option. Grace Lu-Yao of Robert Wood Johnson Medical School in New Jersey was the head of the study. It's the first study involving so many older men. 50% of the men were over 75 and many of their tumors were found through the PSA tests.
As part of this study they used the U.S. government's prostate cancer database. The researchers studied 9,017 men who were diagnosed over a period of ten years, from 1992-2002, with early-stage cancer who did not get prostate surgery, radiation or hormone therapy for at least six months. Most of the men never had any treatment whatsoever.
Ten years later only 3 percent to 7 percent of those with the low-grade or moderate-grade tumors (which are rated by how aggressive the cells appear to be) had died of prostate cancer, while 23 percent of those with high-grade tumors died. Overall, prostate cancer killed only 10 percent of the patients.
It's thought that most of the patients are going to die from something else and because of this most of the older men with the early-stage tumors could delay any treatment. It's not clear what should be done, if anything - whether it's conventional prostate surgery, radiation and hormone therapy or alternative treatment. This may be true even if people are younger or have a more advanced prostate cancer. Most cases are diagnosed in men who are 68 or older, and most are in an early stage.
In any event this large study shows that a large number of men do well with no initial treatment and with no treatment long term. So this new study shows that for older men observation is a reasonable approach. Many patients do well for a long period of time with absolutely no treatment.
To sum up, older men with early-stage prostate cancer are not taking a big risk if they just keep a good eye on the progress instead of going ahead with treatment. It's the largest study to look at this issue since the PSA blood tests to detect prostate tumors became so popular in the 1990s. The study may persuade some middle-of-the-road prostate doctors that we are over-treating prostate cancer and that PSA testing may be magnifying the problem. Finally patients have the opportunity to concentrate on adopting a healthy lifestyle and most importantly adopting a healthy diet.
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