Most Men With Just Low-Risk Prostate Cancer Receive
Aggressive Treatment
Over 90% of prostate cancers diagnosed before they
spread and the 5-year survival rate for these is almost 100%
July 27, 2010 - Most men who are diagnosed with
prostate cancer appear to under undergo aggressive therapy, even if they
have a low prostate-specific antigen (PSA) level and low-risk disease,
according to a report in the July 26 issue of Archives of Internal
Medicine, one of the JAMA/Archives journals.
More than 90 percent of all prostate cancers are
diagnosed before the disease has spread to other parts of the body, and
the five-year survival rate for these patients diagnosed with localized
disease is almost 100 percent, according to background information in
the article.
Researchers studied almost 6,000 senior citizens,
suggest patients be informed about the differences and similarities in
expected outcomes, make treatment decisions with an experienced surgeon
The five-year survival rate from all stages of
disease increased from 69 percent in 1975 to almost 99 percent in 2003.
"The tremendous improvement in survival has been
attributed to early detection and treatment," the authors write.
"However, there have been concerns about the
potential overdiagnosis and overtreatment of localized prostate cancer.
Despite these concerns, some researchers argue that the
prostate-specific antigen (PSA) level is associated with a continuum of
cancer risk and recommend lowering the 4-nanogram per milliliter
threshold for biopsy."
To determine current risk profiles and treatment
patterns of men with prostate cancer and PSA levels below this
threshold, Yu-Hsuan Shao, Ph.D., of the Cancer Institute of New Jersey,
New Brunswick, and colleagues used data from the Surveillance,
Epidemiology and End Results system.
Prostate cancer is the most commonly diagnosed
malignancy and the third leading cause of death from cancer in men in
Western countries - Sept. 13, 2010
Of 123,934 men with newly diagnosed prostate cancer
from 2004 to 2006, 14 percent had PSA levels of 4 nanograms per
milliliter or lower. "The patients in these cases were less likely to
have high-grade cancer, and more than half were classified as having
low-risk cancer," the authors write.
"Despite their lower risk of having clinically
significant disease, treatment rates for men with PSA values of 4.0
nanograms per milliliter or lower were comparable to those of men
presenting with PSA values between 4.0 and 20.0 nanograms per
milliliter."
More than 70 percent of men with PSA values lower
than 20 nanograms per milliliter had their prostates removed via radical
prostatectomy or had radiation therapy.
"Radical prostatectomy was performed on 44 percent
of men with PSA values of 4.0 nanograms per milliliter or lower, 38
percent of men with PSA values between 4.1 and 10.0 nanograms per
milliliter and 24 percent of men with PSA values between 10.1 and 20
nanograms per milliliter,” the authors write.
“Radiation therapy was performed on 33 percent of
men with PSA values of 4.0 nanograms per milliliter or lower, 40 percent
of men with PSA values between 4.1 and 10.0 nanograms per milliliter and
41.3 percent of men with PSA values between 10.1 and 20 nanograms per
milliliter.”
The researchers suggest that if the threshold PSA
value for biopsy were decreased from 4.0 to 2.5 nanograms per
milliliter, the number of men with abnormal PSA levels would double to
approximately 6 million.
"Estimates suggest that 32 percent of men with
abnormal PSA levels would be diagnosed as having prostate cancer from
their needle biopsy," they write.
"Based on the results in the present study, 82.5
percent of these 1.9 million men would receive attempted curative
treatments, while only 2.4 percent would have high-grade cancer.
However, no evidence suggests that delaying biopsy until the PSA level
reaches 4.0 nanograms per milliliter would result in an excessive number
of potentially non-curable disease cases."
"These results underscore the fact that PSA level,
the current biomarker, is not a sufficient basis for treatment
decisions," the authors conclude. "Without the ability to distinguish
indolent from aggressive cancers, lowering the biopsy threshold might
increase the risk of overdiagnosis and overtreatment."
The study was supported by grants from the National
Cancer Institute, Cancer Institute of New Jersey and Robert Wood Johnson
Foundation.
More Links to
Reports on Prostate Cancer in SeniorJournal.com Archives
Androgen-deprivation therapy (ADT) may increase
cardiovascular risk, but unclear whether it’s linked to increased death
from heart disease - Feb. 3, 2010
MIRP, especially with robotic assistance, increased from 1% to 40% of radical prostatectomies from 2001 to
2006,despite limited data on outcomes and costs
Sarcosine is better indicator of advancing disease
than traditional prostate specific antigen test (PSA); it is detected in
urine, researchers hopeful simple urine test can be used
Feb. 12, 2009
About Prostate Cancer
The prostate
is the gland below a man's bladder that produces fluid for
semen. Prostate cancer is the third most common cause of death
from cancer in men of all ages, although it is rare in men
younger than 40.
Levels of a
substance called prostate specific antigen (PSA) is often high
in men with prostate cancer. However, PSA can also be high with
other
prostate conditions. Since the PSA test became common, most
prostate cancers are found before they cause symptoms. Symptoms
of prostate cancer may include
● Problems passing urine, such as pain, difficulty starting
or stopping the stream, or dribbling
● Low back pain
● Pain with ejaculation
Prostate
cancer treatment often depends on the stage of the cancer. How
fast the cancer grows and how different it is from surrounding
tissue helps determine the stage. Treatment may include surgery,
radiation therapy, chemotherapy or control of hormones that
affect the cancer.
July 27, 2010 - Most men who are diagnosed with
prostate cancer appear to under undergo aggressive therapy, even if they
have a low prostate-specific antigen (PSA) level and low-risk disease,
according to a report in the July 26 issue of Archives of Internal
Medicine, one of the JAMA/Archives journals. 
