Panel Recommends Observation Rather Than Treatment for Low Grade Prostate Cancer

This year, approximately 240,000 American men will have been diagnosed with prostate cancer. Because of early screening with PSA, about 100,000 of them will have low-grade prostate cancer which seldom progresses to do the patient any harm (only about 7% will die from low-grade prostate cancer, the rest will have no further problems). A panel of distinguished experts in prostate cancer recommended drastically altering how we categorize these low-grade tumors, and also recommended that doctors seriously discuss with their patients “observation” rather than radical therapies.

The problem up until now has been that men with low-grade disease seldom choose observation. They rather risk the complications of treatment, even if it is unlikely that the disease will result in their death. These procedures include radical prostatectomy and radiation which come with severe side effects like impotence and incontinence.

The best evidence for choosing observation comes from the PIVOT trial, which compared 731 men with prostate cancer randomly assigned to surgical removal of their prostate or observation.

After an average of 10 years of followup, about half the patients had died. But only 7 percent died of prostate cancer, and the risk of dying (from prostate cancer or any cause) was not significantly different between the “treatment” and “observation” groups – if the tumor was initially deemed low-risk.

These results led the panel to strongly recommend that low-grade disease not be called “cancer” and encourage urologists to strongly recommend observation to these patients.

By carefully observing the patient with annual digital rectal exams and PSA screening, tumor progression can be detected in plenty of time to get a cure. However, it all depends on how seriously the patient complies with this schedule.

“Observation” appears to be a good choice for men in their 50s who still want children and men with life-expectancies less than 10  years.

NOTE: Dr. Kreisberg is not a medical doctor and all treatment decisions should be made with careful consultation with your d

 

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