Study Disputes Wait-and-See Approach to Prostate Cancer

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By Rob Stein
Washington Post Staff Writer
Wednesday, December 13, 2006

A large new study is challenging the common practice of recommending that older men forgo treatment for early prostate cancer and instead wait to see whether the malignancy progresses.

The study of more than 44,000 American men ages 65 to 80 found that those who chose to aggressively treat their prostate cancer with surgery or radiation were about 30 percent less likely to die than those who waited, indicating that treatment offered a clear advantage.

The research, published in today's Journal of the American Medical Association, is the first to directly examine what has become conventional wisdom: that many older men need not treat early prostate cancer because it tends to grow so slowly that they will probably die of something else first.

"For many years, the thinking has been that observation or 'watchful waiting' was the safest option for elderly patients with early prostate cancer," said Yu-Ning Wong of the Fox Chase Cancer Center in Philadelphia, who led the study. "This suggests there may be a benefit of treatment, even in this age group."

The findings prompted debate among specialists, who said the results could have potentially far-reaching implications because they address one of the central quandaries about prostate cancer and because the disease is so common. It is diagnosed in 235,000 U.S. men each year and kills more than 27,000, making it the most common cancer and second-leading cancer killer, after lung cancer, among men. Most cases are diagnosed after age 65.

Some experts said they hope the findings will encourage more doctors to consider treating elderly men.

"This debunks the idea that older men do not benefit from treatment," said Christopher L. Amling of the University of Alabama in Birmingham. "This gives support to the idea that active treatment can be beneficial."

Other experts expressed skepticism, saying the study's design may have missed another explanation for the lower death rate among men who were treated: They were probably healthier in ways that doctors can tell only by examining them, not by looking at their medical records, which is what the study's authors did.

"There was probably something about these guys that made them more likely to get treated that also made them more likely to survive," said Mark S. Litwin of the David Geffen School of Medicine at the University of California at Los Angeles, who co-authored an editorial accompanying the paper.

Wong acknowledged that the study's design had limitations, making it important that the findings be confirmed by additional research. But she said she and her colleagues analyzed the data carefully to account for factors that could have influenced the findings, such as the subjects' ages and whether they had other health problems.

"We adjusted for as many of those differences as we could," Wong said.

The widespread use of the prostate-specific antigen, or PSA, screening to detect prostate cancer early has led to intense debate about how aggressively to treat the disease. Some doctors fear the cancer is being over-treated, particularly in older men, subjecting them to therapies that leave many impotent and incontinent when their cancer would never bother them if left untreated. Autopsies show that most men will develop prostate cancer in their lifetimes but often die of something else.


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