Prostate Cancer: Wait To Treat?

(WebMD)  Men with low-risk prostate cancer can safely wait up to six months to get treated without jeopardizing their chances of cancer progression, a study supported by the National Institutes of Health shows.

The findings mean that roughly half of newly diagnosed prostate cancer patients can take their time in choosing the treatment that is right for them, the study's author tells WebMD.

This is especially important in prostate cancer because there are so many different treatment options with a wide range of potential side effects.

"Our study suggests that waiting up to six months to have surgery does not negatively impact a low-risk patient's chance of cure," says Duke University Medical Center urologist and surgeon Stephen Freedland, M.D. "We can't really say what the risks are after this."

Several Treatments, Few Clear Answers

About 230,000 new cases of prostate cancer are diagnosed in the United States each year, and nearly half of those men are considered to have low-risk disease.

The question of how to treat men with these low-risk cancers, or whether to treat them at all, is a complex one. For most patients, there is no clear right answer.

In the newly published study, researchers followed nearly 900 prostate cancer patients to determine if time between diagnosis and surgical treatment affected disease recurrence.

Seventy-five percent of the patients had surgery within three months of diagnosis, while an additional 20% were operated on within three to six months. Only 48 patients (5%) waited longer than six months to have surgery after learning they had prostate cancer.

Recurrence was defined as having a rise in prostate specific antigen (PSA) blood test after surgery. It is used after surgical removal of the prostate to monitor cancer recurrence.

Longer Delays Could Double Risk

While delaying surgery for up to six months was not associated with an increased risk of recurrence, delaying treatment longer appeared to more than double the recurrence risk.

But Freedland says this doesn't necessarily mean that all low-risk prostate cancer patients who wait longer than six months to get treated have a worse prognosis than those treated earlier.

That's because it is not known why the men in the study delayed treatment.

"The men who waited may have originally chosen to have no treatment at all but then something happened to change their minds," he says. "So for these 48 guys who chose to go onto surgery after six months, there may be 1,000 patients out there who had no treatment and are still doing fine."

It is also not clear from the study if men who have radiation instead of surgery can safely delay treatment. But several recent studies involving only radiation patients suggest that this is the case.

Choose Treatment, Doctor Carefully

The study should reassure prostate cancer patients that they can take their time to choose the best treatment for them, but that should not take six months, says Robert A. Smith, Ph.D., director of cancer screening for the American Cancer Society.

"I'm not sure what would be gained by waiting that long, unless the patient is older and decides not to get treated at all," he tells WebMD. "But patients absolutely should take the time to fully understand the different treatment options and the side effects associated with those treatments."

Another important consideration, Smith says, is the experience of the treating surgeon or radiologist.

"Choosing someone with a lot of experience who keeps good data on their patients' side effects is important, because this is highly variable from physician to physician," he says.

Sources: Freedland, S.J. The Journal of Urology, April 2006; Vol. 175: online edition. Stephen J. Freedland, M.D., assistant professor of urology and pathology, department of surgery, Duke University Medical Center and Duke Prostate Center. Robert A. Smith, Ph.D., director of cancer screening, American Cancer Society. News release, Duke University.

By Salynn Boyles
Reviewed by Louise Chang, M.D.
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