Are Prostate Cancer Patients Being Over-Treated?

Thousands of American men are treated for early prostate cancer each year with the majority either undergoing surgery or radiation treatment. But it is now being suggested that perhaps as many as half of those treated would have fared just as well if their cancer had simply been monitored.

Prostate cancer tends to develop late in life and although many men in their forties succumb to the disease, it often does not appear until the sixties or even seventies. In addition, many prostate cancers are very slow growing and a substantial number of men die from other causes before their prostate cancer becomes a real problem. For this reason, it is often felt that even when cancer is diagnosed it is advisable to simply watch and wait and to only intervene when it becomes necessary.

This policy however gives rise to two particular problems.

The first is that when prostate cancer is diagnosed at an early age many men are not happy with a policy of watchful waiting. In some cases this is simply a matter of finding it unacceptable to live with the knowledge that they have cancer and in others it is a case of feeling that, since the cancer has been detected at an early age, it is likely that treatment will be necessary at some point and so it is probably better to sort the problem out now while they're still young and otherwise fit.

The second problem is that there is currently no real way of knowing just when treatment should be undertaken. The currently available tests such as the Gleason score (which examines cancer cells under the microscope), the prostate specific antigen (PSA) blood test, ultrasound examination and biopsy all provide doctors with valuable information, but none give any concrete indication of how the cancer is likely to develop and at what point a relatively small and slow growing cancer may turn aggressive.

At present it is often a case of monitoring prostate cancer until symptoms begin to appear and then, rather than managing the symptoms, to treat the cancer directly at that point. In many cases however it could be argued that the symptoms could be treated relatively easily and that cancer treatment, frequently accompanied by a number of unpleasant side-effects, is not necessary at this point. In some cases treatment would of course be unavoidable at a later date, but in a significant number of men the development of the disease would continue at a sufficiently slow pace that they would die from other causes before treatment became necessary.

The answer to this problem lies in devising a method for assessing the growth potential of prostate cancer so that doctors can decide far more accurately whether the cancer presents a significant risk in individual patients. To this end studies are currently underway and it is hoped that an answer will be found before too long.

In the meantime, if you are facing a diagnosis of prostate cancer then, if your cancer is detected at an early stage, it would be advisable to seek your doctor's advice and think carefully about the best course of action before simply rushing into what might prove to be unnecessary treatment, with all its accompanying side-effects.

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