ANN ARBOR, Mich., Aug. 11 (UPI) -- More than half of men with low-risk prostate cancer would do better with a "watch and wait" approach to their illness, instead of receiving aggressive treatment that produces no survival benefit, says a new study.
But the most formidable barrier to such a measured approach is the nervous patient who has just been diagnosed with cancer and doesn't want to delay a strong counter-attack against the dreaded disease, experts say.
However, new research that appears in the August 16 issue of the Journal of the National Cancer Institute (NCI) supports the "less is more" side of a long-running debate among medical experts on the best prostate cancer strategy.
The research team that conducted the study, led by John Wei and David Miller of the University of Michigan Comprehensive Cancer Center, looked at data on 64,112 men diagnosed with early-stage prostate cancer between 2000 and 2002, whose records are part of NCI's Surveillance, Epidemiology and End Results (SEER) cancer registry.
"Based on data from this study, it is clear that the number of lower-risk patients who receive initial aggressive therapy is not trivial and we have to ask the question whether this is too much treatment for some of these men," said Miller in a press release issued Friday.
"Prostate cancer is not a one-size-fits-all condition and we now know that many men are diagnosed with slowly growing cancers that are unlikely to cause symptoms or be fatal," he said.
The men in the study were assigned to high-risk or low-risk categories based on the aggressiveness of their tumors.
The researchers found that men with low-risk cancers under age 55 are more likely to be treated with surgery instead of watchful waiting, and men aged 70 to 74 usually received radiation therapy instead of watchful waiting. They also found that older men with lower-risk prostate cancers who chose a conservative, watchful waiting approach, were likely to die from another cause during the first 20 years after their cancer diagnosis.
"Given that the average patient often has bothersome side effects of surgery or radiation, such as erectile dysfunction, urinary incontinence, and bowel difficulties, it is important to evaluate the barriers to greater use of expectant management approaches, including active surveillance," Miller said.
Susan Slovin, a physician in the Genitourinary Oncology Service of the Memorial Sloan-Kettering Cancer Center said she thought one of the biggest barriers to using a watch and wait approach was the patient, not the doctor.
"Patients also drive the decision-making process," Slovin told United Press International. "They come in fully armed from the Internet full of ideas about the curative therapy they want. They are worried about their rising (prostate specific antigen) and are very fearful about the prospect of waiting to intercede. I sometimes think that PSA should mean 'promote stress and anxiety' instead of 'prostate specific antigen.'"
Oliver Sartor, a faculty member at the Lank Center for Genitourinary Oncology of the Dana Farber Cancer Institute in Boston, agreed.
"Decision-making for a cancer patient is difficult and often fraught with emotional issues that are more complex than this article might imply," said Sartor. "Certainly all of us in the field agree that a significant portion of patients with prostate cancer are overtreated and suffer unnecessary side effects from their treatment, but they are fearful and unwilling to adopt a watchful waiting approach. If we communicate the risks and benefits of such an approach more clearly, perhaps this will change."
Slovin said she thought the study was important because it provided good information about which prognostic factors determine who will need more aggressive treatment and who can be monitored expectantly, but added that the most crucial element for a successful outcome was treating each case individually.
"I think one of our biggest mistakes is treating patients as a group instead of looking at their individual demographics, including family history and the nature of their tumors," Slovin remarked. "We have to characterize patients by their level of risk at the time of diagnosis, and many factors play into that. We must take them all into account."
