Men diagnosed with early prostate cancer who track their disease have the same survival rate as those who have surgery or radiation, a large study has found.
The study, led by Dr. Freddie Hamdy of the University of Oxford, reports that survival rates from prostate cancer are incredibly high at 99%, regardless of what approach patients took in managing the disease. The results now call into question the issue of what treatment works best, and if early-stage prostate cancer needs intervention at all, which in turn raises doubts on screening with PSA blood tests. These blood tests are useful only if early detection can save lives, CBS reports.
There’s been no hard evidence that treating early disease makes a difference,
Hamdy says. He adds, “Because we cannot determine very well which is aggressive cancer and which is not, men and clinicians can both be anxious about whether the disease will progress. And that pushes them toward treatment.”
Dr. Otis Brawley, chief medical officer for the American Cancer Society, says these results are good news, but that it would be difficult to convince men with early-stage prostate cancer not to undergo radiation or surgery. Brawley suggests monitoring it to his patients, but points out that it can be “challenging” to tell people that some cancers don’t need treatment.
The current aggressive approach towards screening and treatment has brought in over a million American men for whom the procedures were unnecessary, Brawley explained. He was not involved in the study.
The Oxford team’s research studied 82,000 men in the United Kingdom between the ages of 50 to 69. They had PSA tests or prostate specific antigen – high levels can suggest prostate cancer but may also signify harmless conditions like natural enlargement due to age.
Researchers focused on the men with early prostate cancer, where the disease is still confined to the prostate. Of those respondents, 1,643 were randomly assigned to surgery, radiation or constant monitoring. The process included blood tests every three to six months, counseling and discussions for treatment only if symptoms showed the disease to be worsening.
Ten years later, researchers found that there was no difference in the mortality rates among all groups, either from prostate cancer or other causes. But more men who actively monitored their condition got worse, 122 compared to 46 of those who had undergone surgery and 46 of those who had completed radiation. On the other hand, radiation and surgery both brought on side effects such as urinary, bowel and sexual problems.
Quality of life in general in terms of physical movements and mental health were similar across all groups.
The researchers say their results mean there are advantages and disadvantages to each kind of treatment and that patients should discuss all options with their doctors. Jenny Donovan, co-author on the study, says due to the high survival rate among prostate cancer patients, there is no need for rushed decisions.
PSA testing is popular in the USA, even after a government task force released a report saying that routine screening does more harm than good, leading to false alarms and unnecessary treatments.
Donovan says follow-up studies are needed on their respondents to see how survival develops in the next five to 20 years. Other scientists are of the opinion that scientists should look more at which cancers grow slowly and don’t need treatment, and differentiate them from those that do.
The study, funded by Britain’s National Institute for Health Research, was published in the New England Journal of Medicine.