Delaying PCa treatment acceptable in patients with low-grade disease

In patients with low-grade prostate cancer, forgoing immediate radiation or radical prostatectomy poses no added risk of death, say researchers from Johns Hopkins University, Baltimore.

Delaying treatment is acceptable, as 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, according to the authors, who published their findings online in the Journal of Clinical Oncology (April 4, 2011).

The study included 769 men, mostly aged 65 years and older, diagnosed with low-grade prostate cancer. Men were enrolled in the study from 1995 through 2010 and are being monitored through semiannual check-ups and yearly biopsy.

None of the men have so far died from prostate cancer since the study began in 1995. However, one-third of the patients eventually underwent treatment, primarily because annual biopsy results showed more cancer.

"This study offers the most conclusive evidence to date that active surveillance may be the preferred option for the vast majority of older men diagnosed with a very low-grade or small-volume form of prostate cancer," said senior author H. Ballentine Carter, MD. "These are men with a favorable-risk disease profile to begin with.

"Our findings really underscore the need to address excessive treatment of this milder stage of the disease in older men, especially seniors."

The study showed that men who strictly met all study criteria for very low-risk disease were 30% less likely to be reclassified to a high-risk category during surveillance and need subsequent surgery or radiation than men who did not meet one or more study criteria.