Aggressive Treatment for Prostate Cancer Is the Norm
Study Finds Majority of Men Diagnosed With Low-Risk Disease Get Radiation or Radical Surgery
Aggressive Prostate Cancer Treatments: Other Opinions
The new research adds statistics to what has long been known, says Stuart Holden, MD, medical director of the Prostate Cancer Foundation and head of the Louis Warschaw Prostate Cancer Center at Cedars-Sinai Medical Center, Los Angeles, who reviewed the study for WebMD.
"This article is saying that PSA when used alone as a screening tool will tend to uncover many cancers that are harmless and do not need to be treated," he says."However, it will also discover some that do need to be treated."
Aggressive treatment for low-risk cancers is due, he says, to the lack of knowledge experts still have about prostate cancers, Holden says. It's not always possible to distinguish between harmless and aggressive cancers.
Another expert agrees prostate cancer is often overtreated. "There's no question there is a problem of overtreatment of prostate cancer," says Matthew Cooperberg, MD, assistant professor of urology at the University of San Francisco, who has published on the topic of low-risk prostate cancers.
''I think the authors are slightly unfair in their estimation of our ability to risk-stratify the disease and target treatment appropriately," he tells WebMD, noting that doctors take into account other factors besides the PSA level when deciding on the best course of treatment, such as age and other medical tests.
In a commentary accompanying the study, Richard Hoffman, MD, of the University of New Mexico and Steven Zeliadt, PhD, of the University of Washington point out that "once a man is diagnosed as having an early-stage cancer, regardless of his age, he faces a treatment decision."
More recently, however, the commentary writers say, another option has been proposed. Called active surveillance, it involves deferring treatment and monitoring the disease closely. It's a more aggressive approach than the previous and similar approach called watchful waiting, Stein tells WebMD.
"Instead of immediate treatment for men with low-risk disease, active surveillance involves monitoring the cancer by PSA testing and DRE [digital rectal exam] every 3 to 6 months and performing prostate biopsies every 12 to 24 months," the commentary authors write.