Treatment Beats Watchful Waiting for Older Prostate Cancer Patients

Death rate was 31 percent lower in group that got surgery or radiation, study says

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HealthDay Reporter

TUESDAY, Dec. 12, 2006 (HealthDay News) -- Aggressive treatment of early prostate cancer, and not watchful waiting, improves the survival of older men, a new study suggests.

"There has been a belief that watchful waiting was the safest treatment for older men with moderate prostate cancer," said Dr. Yu-Ning Wong, an oncologist at Fox Chase Cancer Center who is lead author of the report in the Dec. 13 issue of the Journal of the American Medical Association. "Our study suggests there may be a survival benefit," Wong said.

But a more definitive answer will have to wait for the outcome of controlled studies that are under way, Wong added.

"Our study was observational," she said. "We looked at the records of men treated or not treated for prostate cancer. It was not a randomized, controlled trial."

The issue of treatment vs. watchful waiting has grown in importance as more men live longer; many are diagnosed with low- and intermediate-grade cancer that poses no immediate threat to their lives.

The study looked at data on more than 44,000 such men, aged 65 to 80, who survived a year or more past diagnosis. About three quarters of them -- 32,000 -- had surgery or radiation therapy in the six months following diagnosis. Another 12,600 did not, as the physicians opted for watchful waiting.

The death rate for men who received treatment was 31 percent lower over a 12-year follow-up period, the researchers reported. The death rate was 23.8 percent for those who had treatment, compared to 37 percent for those who did not.

The reduced death rate was seen in all subgroups, including men aged 75 to 80 at diagnosis and those with low-risk disease.

"The cautionary note when interpreting this trial is that although it suggests that every man should be treated radically, the decision must be made case by case," said Dr. Mark S. Litwin, a professor of urology and public health at the University of California, Los Angeles, and co-author of an accompanying editorial.

As a general principle, "we know that most men don't die from it [prostate cancer], but die with it," Litwin said. "One has to be careful to be sure not to over-treat. The treatment can be worse than the disease."

When making a decision, the doctor "has to be very astute in assessing a patient's general functional status and overall health," Litwin said. And the patient's voice must be heard, he added.

"The patient should be the driving voice," Litwin said. "The physician must be cautious not to be paternalistic because this generally is not an acute, life-threatening illness."

Some smaller studies have indicated a benefit for watchful waiting, but most have found better survival with treatment, Wong said.

"Ultimately, a randomized, controlled trial will give us the answer we are looking for," Litwin said.

Such a trial is being done by the U.S. Veterans Administration, Wong said. Results are expected in a few years.

Until then, "the decision needs to be based on the patient's overall condition and personal beliefs," she said.

More information

The U.S. National Cancer Institute can tell you more about prostate cancer.

SOURCES: Yu-Ning Wong, M.D., medical oncologist, Fox Chase Cancer Center, Philadelphia; Mark S. Litwin, professor, urology and public health, University of California, Los Angeles; Dec. 13, 2006, Journal of the American Medical Association

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