Study Finds Aggressive Approach To Prostate Cancer Treatment The Best
Study Finds Aggressive Approach To Prostate Cancer Treatment The Best
By Ron Swerdfiger
An aggressive approach to treating and preventing the growth of prostate cancer is the best way to attack the disease, and not the traditional tactic of watchful waiting, according to new research. This proved especially true in older men afflicted with prostate cancer.
“There has been a belief that watchful waiting was the safest treatment for older men with moderate prostate cancer,” said study author Dr. Yu-Ning Wong, an oncologist from the University of Pennsylvania. “Our study suggests there may be a survival benefit,” Wong said.
But, he added, a more definitive answer will have to wait for the outcome of future controlled studies currently underway.
“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 versus watchful waiting has gained importance as more men live longer many are diagnosed with low or intermediate grade cancer, which poses no immediate threat to their lives.
The study, published in the December 13 issue of the Journal of the American Medical Association, looked at data on more than 44,000 men, aged 65 to 80, who survived at least 12 months following diagnosis.
32-thousand of these men, roughly three quarters of all participants, underwent treatments such as radiation therapy or surgery within six months of being diagnosed. In the other 12,500 cases, the physician and patients opted for watchful waiting to monitor the condition.
Over a 12-year follow-up period, it was found that the death rate for those who opted for an aggressive strategy was significantly lower then the group who watched and waited. 23.8 percent of those who had treatment died, compared to 37 percent of those who did not.
The reduced death rate was true across all subgroups, including men aged 75 to 80 at the time of diagnosis and those with low-risk forms.
“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 UCLA who contributed to the study s accompanying editorial.
Generally, “we know that most men don t die from it but die with it,” Litwin said of prostate cancer.
“One has to be careful to be sure not to over-treat. The treatment can be worse than the disease.”
When making the crucial decision, the physician “has to be very astute in assessing a patient s general functional status and overall health,” Litwin said. He added the importance of allowing the patient to have a say in the decision-making.
“The patient should be the driving voice,” Litwin said.
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According to Wong, smaller studies in the past have shown benefit to the watchful waiting strategy. However, the majority of research in this area has determined that aggressive treatment is a much more effective life preserving technique, she added.
“Ultimately, a randomized, controlled trial will give us the answer we are looking for,” Litwin said.
A trial that fits this description is currently being performed by the U.S. Veterans Administration, Wong noted. Results are expected in just a few years.
For now, “the decision needs to be based on the patient s overall condition and personal beliefs,” she concluded.
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