“You might say that if any group could have less aggressive treatment, that’s the group you would look at,” says Robert DiPaola, M.D., coauthor of the study and director of the Cancer Institute of New Jersey. “But yet 75 percent of that group had some form of more aggressive treatment—any form of radiation therapy, including seed implants, or surgery.”
When the group of men with low-risk cancer was broken down by age, 40 percent of men 75 and older and 66 percent of men age 65 to 74 received aggressive treatment. And almost 80 percent of younger men ages 55 to 64 received more aggressive treatment.
“The message is not that they shouldn’t be treated,” says DiPaola, “but that they should sit down with their physicians and have an informed discussion about their PSA, the aggressiveness of the tumor, their likelihood of dying of prostate cancer and then make their decision.”
Richard Hoffman, M.D., of the University of New Mexico Cancer Center in Albuquerque who wrote a commentary on the study, agrees. “Men get the message ‘you have cancer’ ” he says. “They don’t realize there are these low-risk prostate cancers, and they should understand all their options.”
One of these options is called “active surveillance,” where patients and their doctors follow the cancer, continue to do PSA tests and biopsies, and adapt treatment decisions accordingly. “Remember, you don’t have to make a decision right away,” says Hoffman. “If the cancer starts out as low-risk, with active surveillance you may have years to decide whether to undergo aggressive treatment.”
The study was funded in part by the National Cancer Institute and the Robert Wood Johnson Foundation. The results and the commentary appeared online in Monday’s Archives of Internal Medicine.
Cathie Gandel is a writer in Bridgehampton, N.Y.