Prostate Cancer: the Bad News
Here’s the bad news about prostate cancer. A higher percentage of men will be diagnosed with prostate cancer than women with breast cancer. One in every six men will be diagnosed with prostate cancer in their lifetime (one in eight women are diagnosed with breast cancer during their lifetime). The risk of prostate cancer increases with age. Two-thirds of prostate cancers are diagnosed in men over age 65 and 80 percent of men over age 80 have some prostate cancer cells in their prostate.
Prostate Cancer: the Good News
Here’s the good news about prostate cancer. Only one in 36 men will die from prostate cancer. That’s because 70% of prostate cancers are low risk cancers. Less than 6% of men with low risk prostate cancer will die from it within 15 years. That means that most men with low risk cancer of the prostate die from other causes.
Low Risk Prostate Cancers
There is controversy regarding the best management of men with low risk cancers. Ninety percent of men with low risk prostate cancer are treated for it with either surgery or radiation therapy. But, a recent study published in the Annals of Internal Medicine found that many of these men might do just as well or even better with no treatment or simple observation. Plus, observation is far less costly. Immediate treatment was found more effective than observation only when it reduced mortality rate by 50%. The authors concluded that 60% of the men who received treatment for low risk prostate cancer likely would not have needed any treatment for prostate cancer in their lifetime.
There are two observation options. One is called watchful waiting and the other is called active surveillance. Watchful waiting means observing men without monitoring them, and then providing them with symptomatic treatment if and when the prostate cancer becomes symptomatic.Watchful waiting traditionally has been reserved for men with less than 10 years to live and who are likely to die from something else during that time.
Active surveillance involves periodic monitoring of the patient with PSA levels, digital rectal examinations, and prostate biopsies, and then providing definitive treatment if there is evidence that the prostate cancer is progressing. It is estimated that 30% of men undergoing active surveillance for low risk prostate cancer will require future treatment. The 10 year survival rate in this group is 97%.
The estimated lifetime risk of dying from prostate cancer is 4.8% with active surveillance, 6% with watchful waiting, 8.9% with initial/immediate treatment.
One problem with any study is applying the findings to a single patient. It’s easy to recommend observation if the patient is someone else and not yourself. But, if you’re the patient with prostate cancer you might tempted to opt for initial treatment. It is certainly understandable than some men will be more comfortable getting immediate treatment rather observation. Any man diagnosed with prostate cancer should have a healthy discussion with his urologist regarding the risks and benefits of any treatment including the risks and benefits of doing nothing.