Aggressive prostate cancer screening recommendations have led 1 million men suffering from the disease to undergo unnecessary treatment, according to Otis Brawley, MD, chief medical officer for the American Cancer Society.
Dr. Brawley's observation followed the publication of a study in the New England Journal of Medicine which showed that men with prostate cancer are likely to live for 10 years whether they receive treatment or not.
Researchers at the University of Oxford in England analyzed approximately 1,600 men, aged 50 to 69 years, who had been diagnosed with prostate cancer. The men either underwent prostatectomy, received external-beam radiation or were closely monitored while receiving no treatment. Overall, only 1% of the men died within 10 years of diagnosis. The cancer spread in 2 to 3% of the men who underwent surgery and radiation treatment, as compared with 6% who were actively monitored. However, men who received surgical or radiotherapy were more likely to experience side effects related to bowel, bladder and sexual function.
After 6 years' follow-up, twice as many men who underwent surgery still experienced bladder control issues and problems related to sexual function, compared with men who underwent radiotherapy or were closely monitored. Roughly half of the men who did not receive initial treatment stayed on active monitoring over the 10-year study period and avoided treatment side effects. More research is needed to determine if surgery or radiotherapy limits cancer growth and improves overall survival beyond 10 years, according to the researchers.
Keeping a close watch on disease progression is a reasonable option for men diagnosed with localized prostate cancer, especially if they have low- or moderate grade-disease, according to Dr. Brawley. "Active surveillance or delayed treatment avoids the side effects from treatment in those who do not need treatment, but there is an increased risk of cancer progression and spread, and some symptoms may increase gradually over time," he says.
