Thursday, July 13, 2017 1:00 am
Prostate cancer treatment can sometimes wait
The biopsy shows cancer, so you have to act fast, right? Not necessarily, if it's a prostate tumor.
Men increasingly have choices if their cancer is found at an early stage, as most cases in the U.S. are. They can treat it right away or monitor with periodic tests and treat later if it worsens or causes symptoms.
Now, long-term results are in from one of the few studies comparing these options in men with tumors confined to the prostate. After 20 years, death rates were roughly similar for those who had immediate surgery and those initially assigned to monitoring, and surgery had more side effects.
It's not all black and white, though. Early stage doesn't necessarily mean low risk. Some results in the study lean in favor of surgery, and it does have some advantages. It also may improve survival for certain groups. Not all cancers are destined to kill. Some prostate tumors are deadly, but most grow so slowly that men will die of something else.
Treatments – surgery, radiation or hormone therapy – can cause impotence, incontinence, infections and other problems, and sometimes do more harm than the disease ever would.
Monitoring doesn't mean do nothing. Men can get frequent tests, and there are more and better ways to detect disease progression now than there used to be, so there's usually still a chance to treat and potentially cure it if it starts to worsen, Andriole said.
Only a few studies have tested monitoring versus immediate treatment. One found no difference in death rates after more than 20 years; another found surgery improved survival odds, but only for men under 65.
Those were done before wide use of PSA blood tests, back when more tumors were found because they caused symptoms, which often means more advanced disease.