As reported by The Harford Courant, September 16, 2009.

Study: Watch and Wait May Be Best Option for Prostate Cancer

By Josh Kovner

For older men with low-grade prostate cancer, the best treatment option might be to hold off on surgery or radiation and watch for any progression of the disease, says a new study co-authored by a University of Connecticut Health Center urologist.

Because modern screening methods are catching the disease so early, many men 65 and older are living 10 years or longer without showing symptoms of the disease, according to the study, which appears in today's Journal of the American Medical Association.

In years past, said Dr. Peter C. Albertsen, 90 percent of men newly diagnosed with prostate cancer elected to have surgery or radiation.

"The assumption has been that a person would die within two or three years of the diagnosis, but that isn't the case," said Albertsen, the UConn researcher who is also professor of surgery and an associate dean at the UConn Medical School.

The point of the study was to encourage doctors and patients to assess the risk of the disease and weigh that against the potential complications of surgery or radiation.

"A person with a new diagnosis of prostate cancer should ask his doctor precisely what would happen if he just watched his tumor," said Albertsen, who has been researching the disease for the past 25 years.

"With many men with low-grade prostate cancer, the risk of the disease is minimal. If you're not going to die, then operating on it won't change anything," he said.

The study looked at more than 14,000 men 65 and older whose localized prostate cancer was detected early by prostate-specific antigen testing, the preferred screening method known as PSA. These men, diagnosed between 1992 and 2002, hadn't had surgery or radiation in the first six months since their diagnoses.

An eight-year follow-up by the team found that the mortality rate in these patients declined significantly compared with the results of earlier studies involving men who were diagnosed in the 1970s and 1980s. These patients also hadn't had surgery or radiation initially, but the disease hadn't been detected as early.

As a result of improved screening methods, the number of men diagnosed with prostate cancer each year has doubled from 90,000 to 180,000, yet deaths have declined only minimally, from 32,000 a year to 27,000. This suggests that surgery and radiation aren't changing the outcome in many cases, Albertsen said.

He worked with the lead author, Grace L. Lu-Yao of the Cancer Institute of New Jersey, and nine other researchers from various institutions, including Harvard Medical School and Massachusetts General Hospital.

Men younger than 65 should still talk to their doctors about the risks of surgery, Albertsen said.