A gnarly problem for patients with a low-risk cancer of the prostate is whether to opt for surgery and also what constitutes adequate monitoring if they do not undergo surgery (see: Solid Advice for Older Men Regarding PSA Screening for Prostate Cancer). A recent article address this issue in a very clear fashion (see: Closely Monitoring Low-Risk Prostate Cancer, With Biopsy, Does Not Raise Risk Of Death And Discourages Overtreatment). Below is an excerpt from it:
A Johns Hopkins study of 769 men from across the United States recently diagnosed with low-grade prostate cancer shows that forgoing immediate surgery to remove the tumor or radiation poses no added risk of death. Delaying treatment is fine, the results show, so long as the cancer’s progression and tumor growth are closely monitored through “active surveillance” and there is no dramatic worsening of the disease over time. None of the men, mostly 65 and older, have so far died from prostate cancer since the study began in 1995. However, one-third of study participants, monitored for as long as 15 years, eventually underwent treatment, primarily because annual biopsy results showed more cancer....The study...is believed to be the largest and longest study of men initially diagnosed with a slow-growing, very nonaggressive form of prostate cancer. This means they stand very little chance of dying from the disease, which was classified as very low risk, in its earliest stage, called T1c....Some 217,000 men in the United States are diagnosed each year with prostate cancer, the majority of them older than 65, and with a low risk of dying from the disease if treatment is deferred, Carter says. Yet, more than 90 percent of these men with low-risk disease, including some 80 percent of those over 75, are likely to choose some form of treatment instead of surveillance. “Our findings really underscore the need to address excessive treatment of this milder stage of the disease in older men, especially seniors,” says [one of the authors of the study]. Possible complications from surgery or radiation to treat tumors, he says, primarily include incontinence, and other bowel, urinary or sexual problems. Just as significantly, Carter and his team notes, their study highlights the importance of carefully selecting patients who are least likely to benefit from treatment....All study participants, 90 percent white and 6 percent black, met the key criteria of having a prostate-cancer Gleason score of 6 or less. The score is used to rate the severity of the disease. Higher scores, typically from 7 through 10, suggest a more aggressive form of the disease that in most cases would require treatment.
The take-home lesson here is that older men with a Gleason score of 6 or less and with a T1c stage of cancer can feel secure if they avoid surgical treatment but rather pursue active surveillance of the disease (see: How is prostate cancer staged?; Gleason Grading System). The details about this more benign surveillance approach should be discussed with your urologist. If your urologist is pressing for surgery for low-risk disease, seek a second opinion. Remember that some urologists may have a financial incentive to perform surgery rather than to offer a surveillance program.
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