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Most Low-Risk Prostate Cancer Patients Receive Aggressive Treatment

Study suggests many men may be treated unnecessarily

by: Cathie Gandel | from: AARP Bulletin | July 26, 2010

Ultrasound enhanced image of a prostate tumor

Ultrasound enhanced view of a prostate tumor. — Science Photo Library/Getty Images

A new study reports that most men with low-risk prostate cancer are nevertheless undergoing aggressive treatment in the form of radiation therapy or surgery, both of which can have significant side effects like impotence or incontinence.

Prostate Cancer Tests

PSA Test: PSA (prostate-specific antigen) is a protein produced by the prostate gland. It is used to screen for prostate cancer, by means of a blood test. An increased PSA level is associated with prostate cancer but may also indicate a noncancerous condition. See the National Cancer Institute fact sheet on PSA.

The Gleason Score: This "score" is determined through a biopsy of the tumor. It grades the tumor in terms of how quickly it is likely to grow. Tumors with higher grades tend to grow and spread faster than those with lower grades.

A team of researchers reviewed data collected by the National Cancer Institute on more than 123,000 men, age 25 and older, who were newly diagnosed with prostate cancer between 2004 and 2006. It’s the first large-scale study to report the type of treatment received by American men with low-risk prostate cancer.

Prostate cancer is the most common cancer diagnosed in men. It can be slow-growing and is not always fatal.

The study looked at the results of a common blood test that screens for prostate cancer by measuring a man’s prostate-specific antigen (PSA) levels. A PSA level lower than 4.0 is generally considered safe, though a small percentage of men with lower levels have an aggressive form of prostate cancer. A number of factors can influence doctors to recommend biopsy when PSA levels are over 4, including symptoms, family history, increasing PSA scores or the size of the prostate.

The researchers found that more than 70 percent of men with PSA levels lower than 20 received either radical prostatectomy—surgery that removes the entire prostate gland plus some surrounding tissue—or radiation therapy, and 44 percent of men with PSA levels below 4 had the radical surgery.

Fourteen percent of all the newly diagnosed men had a PSA level lower than 4, which put them in a low-risk category. More than half of that group also had a low Gleason score, meaning the tumor was slow-growing and not likely to spread. Most men with these low-risk cancers are not likely to die of prostate cancer.