No one ever wants to receive a cancer diagnosis, but the reality is that some forms of cancer are not nearly as dangerous as others. A case in point is prostate cancer, which, according to the medical community, if it is treated at an early stage, is rarely life threatening. Surprisingly, though, new research now suggests that not having any prostate cancer treatment after receiving a positive prostate specific antigen (PSA) test might offer just as good a long-term prognosis as receiving treatment.
The study, which was conducted at the University of Oxford in the United Kingdom, found that men with early prostate cancer who have a doctor monitor the disease regularly rather than undergoing radiation or surgery appear to be equally likely to survive 10 years after their diagnosis.1 Hamdy, Freddie C.; et al. “10-Year Outcomes After Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer.” New England Journal of Medicine. 14 September 2016. Accessed 17 September 2016. http://www.nejm.org/doi/full/10.1056/NEJMoa1606220. The initial subject pool was more than 82,000 men between the ages of 50 and 69. These U.K. residents were all tested for PSA, which may indicate prostate cancer.
The field was narrowed quite a bit as the scientists were only concerned with those participants who were given a diagnosis of localized prostate cancer, at which point the malignancy remains small and has not spread beyond the prostate. There were 1,643 men who met these criteria and were recruited into the investigation. These volunteers were randomly divided into three groups: one that had surgery, a second that underwent radiation, and a third that was actively monitored through checkups every three to six months.
After 10 years of tracking the patients, the researchers evaluated their medical histories and determined that no difference could be found in the death rates either from prostate cancer or another cause among the three groups. What’s more, the overall quality of life was also the same no matter which group a subject had been assigned to based on their physical health, overall mobility, and mental health including depression and anxiety levels.
The results indicated a slightly greater risk of the cancer progressing in those participants who were being monitored than in those who had surgery or radiation treatment. The number of those monitored who got worse was 112, compared to 46 each in the surgery and radiation groups. So while there is a chance either way that the disease will progress, at least in those men who were merely monitored, treatment for the small percentage who eventually need it is only necessary one time. In contrast, in the treatment group, there may be fewer men who receive treatment and still have the cancer progress, but now these patients are forced to undergo a second perilous treatment.
And both surgery and radiation come with a significant set of risks and side effects. The volunteers who received one of these forms of treatment were much more likely to experience urinary incontinence, bowel dysfunction, and/or sexual difficulties. Plus, there are the added considerations that these side effects may linger long after the treatment is completed, as well as the risks inherent in having any type of operation such as reactions to anesthesia, bleeding, blood clots, and infections.
This is hardly the first time that the suggestion has been made to hold off on prostate cancer treatment if the disease is diagnosed early, which it is quite frequently. A 2012 study at the University of Minnesota School of Medicine in Minneapolis showed that radical prostatectomy doesn’t reduce the death risk in prostate cancer patients compared to observation.2 Wilt, Timothy J.; et al. “Radical Prostatectomy versus Observation for Localized Prostate Cancer.” New England Journal of Medicine. 19 July 2012. Accessed 18 September 2016. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429335/.
The new study is important, though, because it represents both a long-term analysis and considers several forms of treatment versus no treatment. And here’s the real kicker in the equation–PSA testing is deeply flawed and produces many false positives that can lead to quite a bit of stress and sometimes excessive, unnecessary treatment. The widespread use of PSA testing has resulted in a dramatic increase in the diagnosis and treatment of prostate cancer, but aside from the large number of false positives, many men do not benefit from intervention because the disease is either indolent or disseminated at diagnosis.
So the bottom line is not to panic if you do have elevated levels of PSA or even a diagnosis of prostate cancer. If your doctor seems gung ho on treatment, see what another specialist has to say. Unless your cancer is aggressive, active monitoring is most likely the safest way to go.
|↑1||Hamdy, Freddie C.; et al. “10-Year Outcomes After Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer.” New England Journal of Medicine. 14 September 2016. Accessed 17 September 2016. http://www.nejm.org/doi/full/10.1056/NEJMoa1606220.|
|↑2||Wilt, Timothy J.; et al. “Radical Prostatectomy versus Observation for Localized Prostate Cancer.” New England Journal of Medicine. 19 July 2012. Accessed 18 September 2016. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429335/.|