Delaying surgery — even for years — for
patients with small, low-grade prostate cancer does not
appear to increase the risk of the disease progressing to
an incurable form, according to a 10-year Johns Hopkins
Medicine study.
The study, published in the March 1 issue of the
Journal of the National Cancer Institute, found the
risk of noncurable prostate cancer — defined as a
less than 75 percent chance of remaining disease-free 10
years after surgery — was the same for men receiving
immediate surgical treatment and those who waited on
average two years before surgery.
"This study suggests that for carefully selected men
with prostate cancer who are monitored, the window of cure
does not close in the short term. For those men diagnosed
with early-stage, low-grade prostate cancer, an alternative
to immediate surgical treatment would be careful
surveillance," said senior author H. Ballentine Carter, a
professor of
urology at the School of Medicine.
Some researchers believe delayed treatment combined
with an active surveillance program could decrease
overtreatment. Others, however, believe postponing surgery
might shift the patient outside the window of
curability.
Men screened for prostate cancer with the prostate
specific antigen test are on average diagnosed with the
cancer 10 years earlier than men not undergoing PSA
screening. While early diagnosis may contribute to a
decrease in prostate cancer mortality in some patients, it
may lead to invasive treatments of a cancer that may never
present a health risk to the patient.
Carter said that Johns Hopkins has been enrolling
patients in a monitoring program since 1995 with great
success, although some patients prefer to go ahead and
pursue treatment for "peace of mind."
"Some patients who learn they have cancer are anxious
to have treatment 'yesterday.' We hope this study will
illustrate that in many cases a safe alternative to
immediate treatment is surveillance," Carter said.
"Specifically, these would be men with small, low-grade
tumors."
Three hundred and twenty men believed to have these
kinds of tumors have been enrolled in an active
surveillance program since 1995. Small, low-grade prostate
cancer was defined as having a PSA density (PSA divided by
prostate volume) below 0.15, no more than two biopsy cores
involved with cancer, no biopsy core that showed more than
50 percent cancerous tissue and no high-grade cancer.
Thirty-eight of these patients delayed surgery for a
median 26.5 months. Outcomes in these men were compared
with a similar group of 150 men who had surgery after a
median three months. Results showed that the risk of
noncurable prostate cancer was the same for both groups.
Factors associated with risk of noncurable prostate cancer
included age at time of diagnosis, PSA level and PSA
density.
Carter said that his group is now studying blood and
tissue samples from this population to better understand
what puts patients at risk while they're being monitored.
He said they plan to look at biomarker changes, genetic
factors and lifestyle choices.
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