Pricier therapy no better for early prostate cancer


Another perfectly good option for men with early prostate cancer is not to get treatment at all, but to wait and see whether the cancer grows or doesn’t cause any harm, researchers said.

“Many men with early disease, especially men who are older, likely don’t need treatment,” said Dr. W. Robert Lee, a radiation oncologist at the Duke University School of Medicine in Durham who wasn’t involved in the new study.

“Active surveillance really plays a very important role,” he told Reuters Health.

Intensity-Modulated Radiation Therapy, Proton Therapy, or Conformal Radiation Therapy and Morbidity and Disease Control in Localized Prostate Cancer

Results Use of IMRT vs conformal radiation therapy increased from 0.15% in 2000 to 95.9% in 2008. In propensity score–adjusted analyses (N = 12 976), men who received IMRT vs conformal radiation therapy were less likely to receive a diagnosis of gastrointestinal morbidities (absolute risk, 13.4 vs 14.7 per 100 person-years; relative risk [RR], 0.91; 95% CI, 0.86-0.96) and hip fractures (absolute risk, 0.8 vs 1.0 per 100 person-years; RR, 0.78; 95% CI, 0.65-0.93) but more likely to receive a diagnosis of erectile dysfunction (absolute risk, 5.9 vs 5.3 per 100 person-years; RR, 1.12; 95% CI, 1.03-1.20). Intensity-modulated radiation therapy patients were less likely to receive additional cancer therapy (absolute risk, 2.5 vs 3.1 per 100 person-years; RR, 0.81; 95% CI, 0.73-0.89). In a propensity score–matched comparison between IMRT and proton therapy (n = 1368), IMRT patients had a lower rate of gastrointestinal morbidity (absolute risk, 12.2 vs 17.8 per 100 person-years; RR, 0.66; 95% CI, 0.55-0.79). There were no significant differences in rates of other morbidities or additional therapies between IMRT and proton therapy.

Conclusions Among patients with nonmetastatic prostate cancer, the use of IMRT compared with conformal radiation therapy was associated with less gastrointestinal morbidity and fewer hip fractures but more erectile dysfunction; IMRT compared with proton therapy was associated with less gastrointestinal morbidity.

  Nathan C. Sheets,
  Gregg H. Goldin,
  Anne-Marie Meyer,
  Yang Wu,
  YunKyung Chang,
  Til Stürmer,
  Jordan A. Holmes,
  Bryce B. Reeve,
  Paul A. Godley,
  William R. Carpenter,
  Ronald C. Chen

JAMA. 2012;307(15):1611-1620.doi:10.1001/jama.2012.460

Cooperberg told Reuters Health that if men find their doctor pushing one treatment option, especially if it’s a high-tech radiation option, they should seek outside opinions and think about their priorities - in terms of what side effects they can put up with and the chance of needing more serious treatment.

Prostate cancer is very much a disease of options,” Lee said.

SOURCE: Journal of the American Medical Association, online April 17, 2012.

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