Aggressive Treatment for Prostate Cancer Is the Norm
Study Finds Majority of Men Diagnosed With Low-Risk Disease Get Radiation or Radical Surgery
Prostate Cancer Treatment Patterns: A Closer Look continued...
Fifty-four percent of the men diagnosed with prostate cancer with a PSA at 4 or lower had low-risk disease, they found. That was also defined as being at stage T2a or lower, with a Gleason score of 6 or lower. A Gleason score, Stein says, is based on "how the cancer looks under the microscope." Scores of 8-10 (10 highest possible) are high-grade tumors, according to the American Cancer Society.
More than 75% of these men with so-called low-risk disease got aggressive therapy, Stein found -- either radical prostatectomy, complete removal of the gland, or radiation therapy.
The decisions are difficult, Stein tells WebMD. "Guys with PSAs under 4 could have lethal cancers," he says.
''These results underscore the fact that PSA level, the current biomarker, is not a sufficient basis for treatment decisions," the researchers write. What's needed, Stein says, are other markers -- such as specific genetic signatures tied to higher-risk disease -- to better predict the risk of a lethal cancer.
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.