Published: Mar. 9, 2006
Updated: Mar. 10, 2006
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By Duke Medicine News and Communications
DURHAM, N.C. -- Waiting up to six months to treat low-risk prostate cancer poses little or no threat of disease progression, according to a multi-university study led by a researcher at the Duke University Medical Center and the Duke Prostate Cancer. This finding reassures men that they can take the time to choose the best treatment option for them, rather than rush into a health care decision immediately, said the researchers.
When men receive a prostate cancer diagnosis, their doctor often gives them a myriad of treatment options, noted the researchers. Possible treatments include removing the prostate, radiation, brachytherapy seeds, cryosurgery and watchful waiting.
While there is no medical benefit to postponing treatment for prostate cancer for six months, the researchers said delaying treatment can allow a patient time to understand the options and pick the best one for him. The side effects of any prostate cancer treatment can include incontinence, impotence and erectile dysfunction.
"There is no one right answer for the treatment of low-risk prostate cancer," said Stephen Freedland, M.D., lead study author and assistant professor in Duke's Department of Surgery-Urology. "It's not uncommon for there to be at least a three to four month delay in action. When these men are diagnosed, there's an initial shock, and they need to get over that. They need time to learn about all the treatments. Plus, if they elect to have surgery, it may take a little bit of time before a surgeon is available." Freedland also holds an appointment in surgery at the Durham VA Medical Center and the Duke Prostate Center.
Researchers published their findings in the March 2006 issue of the Journal of Urology. The study was funded by the Department of Veterans Affairs, the National Institutes of Health, the Department of Defense, the Georgia Cancer Coalition, the Center for Prostate Disease Research, and the American Foundation for Urological Disease.
The study of nearly 900 men with low-risk prostate cancer who underwent prostate removal determined that delaying treatment of up to 180 days did not increase the risk of cancer recurrence. However, men who postponed treatment by more than 180 days were 2.5 times more likely to experience a recurrence, defined as a rise in prostate specific antigen (PSA) to 0.2 ng/ml after surgery. Once the prostate has been removed, the level of PSA should be zero. PSA is a characteristic protein produced by the prostate gland that is secreted into the bloodstream and can be used to help diagnose prostate cancer as well as follow men for signs of cancer recurrence.
According to the National Cancer Institute, approximately 232,000 men are diagnosed with prostate cancer every year, and nearly 30,000 men die from prostate cancer each year. Approximately half of the men newly diagnosed will have low-risk disease. Prostate cancer is considered low-risk if the PSA level is below 10 and the Gleason sum -- how the cancer appears under the microscope -- is less than 7 out of 10.
Freedland said that more research is needed to determine whether treatment delays of greater than six months actually increase the chances of cancer recurrence after surgery. The relatively low number of men with long delays before treatment and the lack of information about why these delays occurred, means doctors should view increased risk of recurrences in this study cautiously, he added.
Delayed treatment or expectant management is often used as first line therapy for older men with prostate cancer, Freedland said.
"Prostate cancer is a slow-growing cancer, but it is still a growing cancer," Freedland said. "For men in their 40s and 50s, we tend to treat the disease aggressively. For men who are older, they may live with this cancer for the rest of their lives and die of something else. So in some cases, waiting for treatment and even just monitoring the cancer growth may be effective and help the patient maintain a higher level of quality of life."
This study is the latest analysis of the Shared Equal Access Regional Cancer Hospital (SEARCH) Database. SEARCH holds information about patient age at surgery, race, height, weight, grade of cancer and preoperative PSA, and other statistics on more than 2,000 patients treated with radical prostatectomy between 1988 and 2004 at the Veterans Affairs Medical Centers in Los Angeles, Palo Alto and San Francisco, Calif., Augusta, Ga., and San Diego Naval Hospital.
In addition to Freedland, who conducted much of the research while a clinical instructor at the Johns Hopkins Brady Urological Institute, other co-authors were Christopher Kane, M.D, San Francisco VA Medical Center and the University of California-San Francisco School of Medicine, Christopher Amling, M.D., San Diego Naval Hospital and University of Alabama School of Medicine, William Aronson, M.D., West Los Angeles VA Medical Center and the University of California-Los Angeles School of Medicine, Joseph Presti, Jr., M.D., Stanford University School of Medicine and the Palo Alto VA Medical Center, and Martha Terris, Augusta VA Medical Center and the Medical College of Georgia.