Men’s Health: Men with low-risk prostate cancer still want treatment

Few are willing to accept a strategy of holding off on therapy until tests show it is needed

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Men with very low-risk prostate cancer that will likely never be life-threatening are nevertheless choosing surgery or radiation to get rid of the tumour rather than delaying treatment until there is evidence the disease is spreading.

In fact, a recent study shows that among men who were diagnosed with slow-growing, non-aggressive prostate cancer, less than 10 per cent of them were willing to accept the option of “active surveillance” — regular rectal examinations and blood tests along with biopsy as needed.

“Active surveillance appears to be an under-utilized strategy for managing patients with very low-risk disease,” says Dr. Daniel Barocas, chief resident in urology at New York-Presbyterian Hospital-Weill Cornell Medical Center in New York. “It suggests a number of these patients are receiving over-treatment.”

Barocas used a database to identify 310 men who had low-risk prostate cancer. Of those men, 28 eventually decided they would accept active surveillance. The rest opted for definitive treatment with surgery or radiation.

Dr. Eric Klein, professor of surgery and head of urologic oncology at the Glickman Urological Institute of the Cleveland Clinic Foundation, says most men probably opted for treatment because even though the risk of the cancer spreading and becoming life-threatening is low, “We really do not have a good way of predicting who will get in trouble with this type of cancer.” He says these indolent cancers rarely begin to grow, but if they do grow, about one in four will prove incurable.

Barocas says the men most likely to accept active surveillance in his study were those over the age of 70.

Active surveillance differs from another conservative strategy called watchful waiting. In watchful waiting, treatment is not usually initiated until a man develops symptoms. In active surveillance, men are routinely tested.