28 Jul, 2010 in
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Study Finds Majority of Men Diagnosed With Low-Risk Disease Get Radiation or Radical Surgery By Reviewed By July 26, 2010 — More than 75% of men diagnosed with low-risk prostate cancer undergo aggressive treatment — either total removal of the prostate or radiation therapy, according to a recent study. That’s real, the researchers found, even in men with a abridged level of prostate-specific antigen (PSA) of under 4 nanograms per milliliter, one of the factors used into account when treatment decisions are made. “If we knew for sure everyone with a PSA under 4 would not die of prostate cancer, case closed,” says researcher Mark N. Stein, MD, a health examination oncologist at The Cancer Institute of Recent Jersey as well as assistant professor of medicine at the UMDNJ-Robert Wood Johnson Health examination School, Recent Brunswick. But that’s far from real, Stein says. As well as that makes the balance between overtreatment as well as undertreatment difficult, he says. The report is appears in the Archives of Internal Medicine. “The tremendous improvement in survival has been attributed to beginning detection as well as treatment,” Stein as well as his colleagues write. “However, there possess been concerns about the potential overdiagnosis as well as overtreatment of localized prostate cancer.” In the study, they looked at data from nearly 124,000 men with newly diagnosed prostate cancer from 2004 to 2006 to determine which men received aggressive treatment. More than 192,000 recent cases of prostate cancer were diagnosed in 2009, according to the American Cancer Society, as well as more than 27,000 men died of it. Prostate Cancer Treatment Patterns: A Closer LookStein as well as his team looked at data from the SEER database, which drew from 16 tumor registries as well as covers about 26% of the U.S. population. In all, 14% of the men had a PSA of 4 nanograms per milliliter or lower. The PSA test measures prostate-specific antigen, a protein produced by the prostate. Typically, the higher the PSA level, the higher the risk of prostate cancer, although some men can possess an elevated PSA without cancer as well as some men can possess cancer without an elevated PSA. Most wholesome men without prostate cancer will possess a PSA of less than 4 nanograms per milliliter, so that level is a common cutoff as to whether to proceed to biopsy, although some say the threshold should be lower as well as adjusted for age. Fifty-four percent of the men diagnosed with prostate cancer with a PSA at 4 or lower had low-risk disease, they found. That was as well as defined as being at stage T2a or lower, with a Gleason score of 6 or lower. A Gleason score, Stein says, is based on “how the cancer looks under the microscope.” Scores of 8-10 (10 highest possible) are high-grade tumors, according to the American Cancer Society.
More than 75% of these men with so-called low-risk disease got aggressive therapy, Stein found — either radical prostatectomy, total removal of the gland, or radiation therapy. The decisions are difficult, Stein tells WebMD. “Guys with PSAs under 4 could possess lethal cancers,” he says. “These results underscore the fact that PSA level, the current biomarker, isn’t a sufficient basis for treatment decisions,” the researchers write. What’s needed, Stein says, are other markers — such as specific genetic signatures tied to higher-risk disease — to best predict the risk of a lethal cancer. Aggressive Prostate Cancer Treatments: Other OpinionsThe recent research adds statistics to what has extended been known, says Stuart Holden, MD, health examination director of the Prostate Cancer Foundation as well as head of the Louis Warschaw Prostate Cancer Center at Cedars-Sinai Health examination Center, Los Angeles, who reviewed the study for WebMD. “This article is saying that PSA when used alone as a screening tool will tend to uncover many cancers that are harmless as well as dont need to be treated,” he says.”However, it will as well as discover some that do need to be treated.” Aggressive treatment for low-risk cancers is due, he says, to the lack of knowledge experts still possess about prostate cancers, Holden says. It’s not always likely to distinguish between harmless as well as aggressive cancers. Another expert agrees prostate cancer is often overtreated. “There’s no question there is a problem of overtreatment of prostate cancer,” says Matthew Cooperberg, MD, assistant professor of urology at the University of San Francisco, who has published on the topic of low-risk prostate cancers. “I think the authors are slightly unfair in their estimation of our ability to risk-stratify the disease as well as target treatment appropriately,” he tells WebMD, noting that doctors take into account other factors besides the PSA level when deciding on the best course of treatment, such as age as well as other health examination tests. In a commentary accompanying the study, Richard Hoffman, MD, of the University of Recent Mexico as well as Steven Zeliadt, PhD, of the University of Washington point out that “once a man is diagnosed as having an early-stage cancer, regardless of his age, he faces a treatment decision.” More recently, but, the commentary writers say, another option has been proposed. Called active surveillance, it involves deferring treatment as well as monitoring the disease closely. It’s a more aggressive approach than the previous as well as similar approach called watchful watchful waiting, Stein tells WebMD. “Instead of immediate treatment for men with low-risk disease, active surveillance involves monitoring the cancer by PSA testing as well as DRE [digital rectal exam] every 3 to 6 months as well as performing prostate biopsies every 12 to 24 months,” the commentary authors write. SOURCES: Mark N. Stein, MD, health examination oncologist, The Cancer Institute of Recent Jersey; assistant professor of medicine, University of Medicine as well as Dentistry of Recent Jersey –Robert Wood Johnson Health examination School, Recent Brunswick. |
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