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Tue 29 Aug 2006 04:00 AM

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Low-risk prostate cancer may be overtreated

Approximately half of men diagnosed with low-risk prostate cancer undergo surgery or radiation therapy when “watchful waiting” may be more appropriate, according to a University of Michigan research team.

Approximately half of men diagnosed with low-risk prostate cancer undergo surgery or radiation therapy when “watchful waiting” may be more appropriate, according to a University of Michigan research team.

Recent studies have revealed that “expectant management”, or regular check-ups to monitor whether treatment is necessary, is a valid option for men with early stage prostate cancer, writes Dr John Weil in the Journal of the National Cancer Institute.

Dr Wei and his team analysed national databases to identity 71,602 men diagnosed with localised or regional cancer of the prostate between January 2000 and December 2002. The risk to the patients from their condition was based on how clearly defined their tumour was.

A “lower-risk” prostate cancer group was classified as “men of any age at diagnosis with well-differentiated tumours, or men 70 years or older at diagnosis with moderately differentiated tumours.”

Approximately a third of subjects (24,825) were classified as having lower risk cancer. Despite being good candidates for the “watchful waiting” approach, 55% underwent immediate treatment; 45% received radiation therapy and 10% underwent surgical removal of the prostate. The team defined this as overtreatment.

Dr Wei and associates wrote, “Just as a failure to treat a potentially lethal prostate cancer is generally considered inappropriate from a quality-of-care perspective, aggressive treatment of indolent cancers (i.e. overtreatment) may also reflect suboptimal care in that it confers risk to patients and increases costs without providing health benefits.”

Wei’s team added that “initial expectant management need not be a permanent treatment choice, and that some men, particularly younger patients, should eventually proceed to appropriate curative therapy after a period of asymptomatic expectant management.”

The team recommended “active surveillance with delayed intervention” as an “appealing approach to addressing overtreatment concerns among men with lower-risk prostate cancer.”

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