More evidence not all prostate cancers need treatment

In a study of older men who had died from causes other than prostate cancer, almost half were found to have prostate tumors.

And up to half of those tumors detected on autopsy would have qualified for treatment had doctors known about them while the men lived, though none had been the cause of death.

That suggests the criteria for treatment "might be worth reexamining," according to the study authors, and adds to a growing body of evidence that a wait-and-see approach might be better than treatment for many prostate cancers.

"The study suggests that the progression of early prostate cancer, including some more aggressive forms of the disease, is far from inevitable within a man's lifetime as many such tumors are found in men who died from other causes when their prostate is analyzed on autopsy," said lead author Dr. Alexandre Zlotta, director of Uro-oncology at Mount Sinai Hospital in New York.

"The study concludes that it is probably worth re-examining our current definitions of clinically unimportant and clinically significant prostate cancer," Zlotta told Reuters Health by email.

He and his colleagues examined the prostate glands of more than 300 men over 60 who had died from a variety of causes, but not prostate cancer. They autopsied 220 men in Russia and 100 in Japan, both countries where the prostate-specific antigen (PSA) screening test is not as commonly used as in the United States.

Medicare currently covers a yearly PSA test for men over 50 who qualify.

Zlotta and his colleagues selected a Caucasian population of Russian men similar in lifestyle and risk factors for prostate cancer to U.S. men in order to look at how common the cancer is in older men who have not been routinely screened.

In the U.S., the number of tumors they found would have been much lower because many would have been identified by screening and treated or removed before death, Zlotta pointed out.

Death Rates by Race/Ethnicity From 1999–2009, the rate of men dying from prostate cancer has varied, depending on their race and ethnicity. The graph below shows that in 2009, black men were more likely to die of prostate cancer than any other group, followed by white, Hispanic, American Indian/Alaska Native, and Asian/Pacific Islander men.

Incidence Rates by Race/Ethnicity
"Incidence rate" means how many men out of a given number get the disease each year. The graph below shows how many men out of 100,000 got prostate cancer each year during the years 1999–2009. The year 2009 is the most recent year for which numbers have been reported. The prostate cancer incidence rate is grouped by race and ethnicity.

The graph below shows that in 2009, black men had the highest rate of getting prostate cancer, followed by white, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native men.