Delaying therapy OK for low-risk prostate cancer

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Men with early, slow-growing prostate cancer may safely wait up to six months before starting treatment, a new study suggests.

Researchers found that among 895 men with so-called low-risk prostate cancer, those who waited up to six months before undergoing surgery to remove the prostate had no increased risk of disease recurrence. There was, however, evidence that men who waited longer than six months were more likely to show “biological progression,” a marker of possible cancer recurrence.

Because this group included a relatively small number of men—and because it’s unclear why they delayed therapy—it’s too soon to draw conclusions about the finding, according to the study’s lead author.

"It’s concerning, and it needs to be confirmed in further studies,” said Dr. Stephen J. Freedland of Duke University Medical Center in Durham, North Carolina.

For now, he told Reuters Health, the overall findings should reassure men with low-risk prostate cancer that they don’t have to rush into a treatment decision after they’re diagnosed.

“Take some time, understand the treatment options,” Freedland said.

The issue of prostate cancer treatment is still controversial. Because the disease is often slow-growing, one of the options is “watchful waiting”—delaying treatment and instead monitoring patients for signs of progression. The point is to spare men the side effects of treatments like surgery, radiation and hormone therapy.

For men who are elderly and have other serious health problems, the risks of prostate cancer treatment may outweigh the benefits. But it has not been clear whether watchful waiting—or just a delay in choosing a treatment—might dim the prognosis of men with low-risk cancer.

The current findings, Freedland said, support the belief that postponing therapy is a “reasonable option” for them.

The study, published in the Journal of Urology, included 895 men with low-risk prostate cancer who underwent surgery between 1988 and 2004. Three-quarters had their prostate glands removed within three months of diagnosis, while most of the remaining men had surgery within six months.

Men in the latter group, the researchers found, were not at greater risk of biological progression after their surgery.

The same was not true of the small number of men who waited more than six months to have surgery. They were two to three times more likely than men who had surgery within three months to develop signs of cancer recurrence, the study found.

Still, Freedland said he is “not convinced” that the longer treatment delays themselves are responsible for the finding. More studies, he said, are needed to answer this question.

SOURCE: Journal of Urology, March 2006. 

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