Health News-Reuters.com
Tue Aug 15, 2006. NEW YORK (Reuters Health) - Approximately one half of men diagnosed with low-risk prostate cancer undergo surgery or radiation therapy when "watchful waiting" may be more appropriate, according to a research team at the University of Michigan in Ann Arbor.
Recent studies have shown that watchful waiting or "expectant management" -- regular check ups to see if treatment is necessary -- is a valid option for men with early-stage prostate cancer, Dr. John T. Wei and his associates note in their article in the Journal of the National Cancer Institute.
"Just as a failure to treat a potentially lethal prostate cancer is generally considered inappropriate from a quality-of-care perspective," they continue, "aggressive treatment of indolent cancers (i.e., overtreatment) may also reflect suboptimal care in that it confers risk to patients and increases costs without providing health benefits."
Wei's team evaluated information in national databases to identify 71,602 men diagnosed with localized or regional cancer of the prostate between January 2000 and December 2002.
The risk to the patients from their cancers was based on how well differentiated the tumor was; that is, how clearly defined it was, rather than spread-out with indistinct boundaries.
A "lower risk" prostate cancer group was classified as "men of any age at diagnosis with well-differentiated tumors or men 70 years or older at diagnosis with moderately differentiated tumors."
Approximately a third of subjects (24,825) were classified as having lower risk cancer. They were good candidates for a watchful waiting approach, but in fact 55 percent underwent immediate treatment -- 45 percent received radiation therapy and 10 percent underwent surgical removal of the prostate -- which equated to overtreatment.
Wei's team emphasizes that "initial expectant management need not be a permanent treatment choice, and that some men, particularly younger patients, should eventually proceed to appropriate curative therapy after a period of asymptomatic expectant management."
They therefore recommend "active surveillance with delayed intervention " as "an appealing approach to addressing overtreatment concerns among men with lower-risk prostate cancer."
SOURCE: Journal of the National Cancer Institute, August 16, 2006.
© Reuters 2006. All Rights Reserved.
