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Suitably chosen prostate cancer patients, who may include older men and men with small low-risk tumors, could carefully postpone treatment for several years with no unpleasant consequences. This was claimed by a new study at Beth Israel Deaconess Medical Center.

With the advent of PSA (prostate antigen) screening nearly 20 years ago, doctors started to detect prostate cancers at much earlier stages. This was explained by corresponding author Dr. Martin Sanda, Director of the Prostate Cancer Center at BIDMC and Associate Professor of Surgery at Harvard Medical School.

Dr Martin Sanda commented, “Consequently, while PSA testing has enabled us to successfully begin aggressive treatment of high-risk cancers at an earlier stage, it has also resulted in the diagnosis of cancers that are so small they pose no near-term danger and possibly no long-term danger.”

Sanda, jointly with coauthors from Brigham and Women’s Hospital, the Harvard School of Public Health and the University of California, San Francisco, checked the Health Professionals Follow-Up Study which is a big cohort study including about 51,529 men who have apparently been followed since 1986. Every two years, the participants supposedly replied to questionnaires about diseases and health-related topics, as well as whether they have been diagnosed with prostate cancer.

A sum of about 3,331 men apparently accounted to receive a diagnosis of prostate cancer between 1986 and 2007. Additional study discovered that among this sub-group, about 342 men, just over 10 percent had apparently chosen to postpone treatment for one year or longer. After 10 to 15 years, half of the men who had primarily delayed treatment apparently still had not gone through any treatment for prostate cancer.

Sanda explained, “We wanted to find out how this group of men fared in the long-term. So we looked at the data they provided us at an average of eight years after their initial diagnosis, and compared it with data provided by prostate-cancer patients who had opted for aggressive treatment, such as surgery, radiotherapy or hormonal therapy. We found that the deaths attributed to prostate cancer were very low among the men with low-risk tumors. Our analysis showed that only two percent of the men who deferred treatment eventually died of the disease, compared with one percent of the men who began treatment immediately following their diagnosis. This is not a statistically significant difference.”

The three types of prostate cancer were identified as high risk, which may be big, quicker growing cancers, intermediate risk and low-risk, which could be small and slower growing cancers. There is apparently plenty of proof that treating intermediate and high-risk cancers with surgery, radiation or hormone therapy may save lives. But how to take care for low-risk cancer supposedly is not certain.

Sanda remarked, “These findings showed that men diagnosed with low-risk tumors who deferred treatment were still doing fine an average of eight years — and up to 20 years — following their diagnosis. In fact, only half of these men wound up undergoing any treatment 10 to 15 years post-diagnosis. This means that they were able to avoid the disruption in their quality of life which might have occurred had they undergone immediate treatment.”

Sanda adds, “If this approach was more broadly accepted as a standard care option for suitable low-risk prostate cancers, it might help us avoid throwing the baby out with the bathwater when it comes to the PSA test. Instead of just abandoning the PSA test because it might be leading to an overdiagnosis of prostate cancer, we could conduct PSA screening in a way that allows more aggressive prostate cancers to be treated, while less aggressive tumors could initially be monitored.”

Sanda believes that this would avoid problems due to treatment of ‘overdiagnosed’ low-risk cancers, while preserving the life saving benefits of treating aggressive cancers that have been detected through PSA testing.

This study was published in the Journal of Clinical Oncology (JCO).