Is Prostate Cancer Overtreated?

More than half of men with low-risk prostate cancer are overtreated with surgery or radiation therapy, a University of Michigan study shows.

David C. Miller, M.D., MPH, and colleagues looked at National Cancer Institute data on 24,405 men with lower-risk prostate cancer. These are men of any age with low-grade tumors or men aged 70 or older with moderate-grade tumors.

Low-grade tumors don't always become dangerous. And if they do, there's still time to act before they turn deadly. Men over 70 with moderate-grade prostate tumors are most likely to die of something other than prostate cancer over the 20 years after diagnosis.

Miller's research team found that 55 percent of men with these low-risk prostate cancers underwent surgery or radiation treatment within a year of diagnosis.

Miller and colleagues note that early treatment for prostate cancer helps many men. But for many others, early surgery or radiation therapy means suffering bothersome side effects but getting little benefit in return.

"It is clear that the number of lower-risk patients who receive initial aggressive therapy is not trivial," Miller said, in a news release. "We have to ask the question whether this is too much treatment for some of these men."

Miller and colleagues note that men who learn they have cancer — and their doctors — often want to take an action-oriented response. But acting too fast, they suggest, is as bad as acting too slowly.

"In our view, if the treatment decision is inappropriate for an individual patient, then no matter how skillfully surgery is performed or radiation is delivered, it is poor-quality treatment," they conclude. "For this reason, efforts to reduce overtreatment should be a clinical and public health priority."

The study appears in the Aug. 16 issue of the Journal of the National Cancer Institute. Miller is now at the David Geffen School of Medicine at UCLA.

SOURCES: Miller, D.C. Journal of the National Cancer Institute, Aug. 16, 2006; Vol. 98: pp. 1134-1141. News release, University of Michigan.

By Daniel J. DeNoon. Reviewed by Louise Chang, M.D