Treat or monitor early prostate cancer?

Study examines whether treatment makes a difference

Associated Press

Men with early prostate cancer who choose to closely monitor their disease are just as likely to survive at least 10 years as those who have surgery or radiation, finds a major study that directly tested and compared these options.

Survival from prostate cancer was so high — 99 percent, regardless of which approach men had — that the results call into question not only what treatment is best but also whether any treatment at all is needed for early-stage cases. And that in turn adds to concern about screening with PSA blood tests, because screening is worthwhile only if finding cancer earlier saves lives.

“There’s been no hard evidence that treating early disease makes a difference,” said Freddie Hamdy of the University of Oxford, the study’s leader.

“Because we cannot determine very well which is aggressive cancer and which is not, men and clinicians can both be anxious about whether the disease will progress,” he said. “And that pushes them toward treatment.”

Otis Brawley, chief medical officer for the American Cancer Society who had no role in the study, welcomed the results but said it would be a struggle to convince men diagnosed with early prostate cancer in the U.S. to skip surgery or radiation. He said he often suggests monitoring but “it’s a challenging process to explain to people that certain cancers just don’t need to be treated.”

Peter Scardino, a prostate surgeon and chairman of the department of surgery at Memorial Sloan Kettering Cancer Center in New York who was not involved in the study, said the research was important because there was little previous data comparing surgery, radiation and careful monitoring in men with early prostate cancer.

Dr. Scardino said active monitoring is appropriate for a third to a half of men with early prostate cancers, and that only a third of those patients would need treatment within 10 years.

The research was published online Wednesday in the New England Journal of Medicine.

In the U.S., about 181,000 prostate cancer cases and 26,000 deaths are expected in 2016. The average age at diagnosis is 66 in the U.S., and the disease rarely occurs in men under 40. Most men who have prostate cancer do not die from it, according to the American Cancer Society.

In 2012, the U.S. Preventive Services Task Force, an independent panel of experts picked by the government, recommended against routine screening for prostate cancer with the PSA test, which remains popular. The group said screening finds many tumors that may never have harmed the patient, and leads too many men into unneeded surgery or radiation, with their troubling side effects.

In Europe, prostate cancer screening is far less common.

The research published Wednesday was paid for by Britain’s National Institute for Health Research.

The study involved more than 82,000 men in the United Kingdom, aged 50 to 69, who had tests for PSA, or prostate specific antigen. High levels can signal prostate cancer but also may signal more harmless conditions, including natural enlargement that occurs with age.

Researchers focused on the men diagnosed with early prostate cancer, where the disease is small and confined to the prostate. Of those men, 1,643 agreed to be randomly assigned to get surgery, radiation or active monitoring. That involves blood tests every three to six months, counseling and consideration of treatment only if signs suggested worsening disease.

A decade later, researchers found no difference among the groups in rates of death from prostate cancer or other causes. More men being monitored saw their cancers worsen — 112 versus 46 given surgery and 46 given radiation. But radiation and surgery brought more side effects, especially urinary, bowel or sexual problems.