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No Treatment May Be Best for Prostate Cancer

Some Men May Not Need Surgery or Radiation for Early Stage of Disease

Scoring Prostate Cancer

The researchers found that the risk of dying depended on the aggressiveness of the prostate cancer as measured by a rating system called the Gleason score.

Researchers found that men with a low Gleason score of 2 to 4 had a very low chance of dying during the 20-year study. Men with scores of 8 to 10 - indicating highly aggressive cancers -- had a high likelihood of death from prostate cancer. Men with scores of 5 or 6 fell in the middle.

In the U.S., where men are aggressively screened for prostate cancer, fewer large tumors -- and more and more low-grade tumors confined to the prostate -- are being diagnosed. Albertsen says more than half of newly diagnosed prostate cancers involve low-grade tumors (Gleason score of 6 or less) that have not spread outside the prostate.

He says aggressive treatment may be justifiable for otherwise healthy, younger men with these tumors. But for older patients with other health problems, aggressive treatment often makes little sense.

"For patients who are older than 65 the likelihood that these tumors will pose a threat to longevity is quite low," he says.

Cancer Treatment Decisions Not Easy

In an editorial accompanying the study, prostate cancer treatment experts Peter Gann, MD, and Misop Han, MD, of Northwestern University, wrote that the findings reinforce the importance of Gleason scoring for predicting outcomes among men with early-stage prostate cancer.

But Han tells WebMD that the optimal treatment protocol for men with localized, low-grade tumors remains unknown.

He points out that the death rate from these prostate cancers isn't zero, and, therefore, the decision on whether or not to treat isn't easy.

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