Treating prostate cancer conservatively may be OK

NEW YORK (Reuters Health) - New research indicates that treating early stage prostate cancer less aggressively is a good alternative, and that outcomes using such an approach - sometimes referred to as "watchful waiting" - have improved in the last few decades.

Men who are diagnosed with prostate cancer have a number of options, including radiation, surgery, or doing nothing but frequent checkups by a doctor, also known as watchful waiting. Recent studies have suggested some early stage cancers may not kill the men diagnosed with them.

According to the report in the Journal of the American Medical Association, outcomes for conservatively managed cancers diagnosed from 1992 to 2002 -- the so-called PSA era, for the prostate-specific antigen test used to test for the disease -- are better than those for cancers diagnosed in the 1970s and 1980s.

Exactly why outcomes have improved is unclear, but it could be due to earlier diagnosis, overdiagnosis due to PSA testing, or advances in medical care, write Dr. Grace L. Lu-Yao, from the Robert Wood Johnson Medical School, New Brunswick, New Jersey, and colleagues.

Both earlier diagnosis and overdiagnosis could lead to what seem like improved outcomes because men in those groups were unlikely to be killed by their prostate cancers, and would boost the number of "good" outcomes overall.

Lu-Yao and colleagues studied 14,516 men with early stage prostate cancers who were diagnosed from 1992 to 2002 and decided to have neither radiation nor surgery for at least 6 months. They were compared with patients treated similarly in the 1970s and 1980s.

In the 1992 to 2002 group, the risk of dying from prostate cancer within 10 years ranged from about 8 percent to about 26 percent, depending on the stage and type of prostate cancer. During the same period, more than half of the men with any particular stage or type of prostate cancer died of something else.

The risk of dying from prostate cancer was higher for men diagnosed in earlier decades. For example, for men 66 to 74 years of age with a particular kind of tumor diagnosed between 1992 and 2002, the likelihood of dying of prostate cancer within 10 years (about 6 percent) was smaller than it was for those diagnosed in the decades prior to 1992 (between 15 and 23 percent).

Considering the findings, men with a life expectancy of less than 10 years may want to consider watchful waiting instead of aggressive treatment directed at a cure, the authors conclude.

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