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6 April 2006
No Action Sometimes The Best Option For Prostate Cancer
by George Atkinson

"Watchful waiting" without treatment is sometimes a course of action for men diagnosed with low-risk prostate cancer, thus avoiding options such as invasive surgery and radiation therapy, which can unduly impact the patient's quality of life. Now, "watchful waiting" will be the subject of a new study being undertaken at the University of Texas M. D. Anderson Cancer Center. The study will follow low-risk patients eligible for watchful waiting to determine if they can avoid or postpone therapy and its related side effects, and still live as long as patients who receive invasive therapy.

The researchers hope the study will provide a foundation for future guidelines on the treatment of low-risk prostate cancer.

Every year, hundreds-of-thousands of men have early stage prostate cancer detected via routine PSA tests, but researcher Jeri Kim thinks that invasive therapy is not necessarily the best option in all cases. "With the advent of the PSA test, we see prostate cancer detected much earlier but there is no evidence that early detection means longer survival. Because of the sensitivity of the test, clinically insignificant tumors sometimes are over-diagnosed and patients may, as a consequence, be over-treated with radiation and surgery," he explained.

Kim added that prostate cancer was one of only a few cancers that can be latent in the body for some time, and not require immediate treatment. "Many researchers have documented over the years that men die with their disease rather than from it, and while we need to intervene early, we also need to intervene appropriately with respect to the stage of disease, the man's age, his health in general and quality of life," he concluded.

Elsewhere, a review in the journal CANCER, has found that men's prostate treatment decisions are frequently based on perception, rather than fact. Investigators from the Fred Hutchinson Cancer Center say that the lack of consistent messages about treatment options compels men to turn to a variety of popular - and often biased - sources, often resulting in treatments that do not reflect the patient's goals.

Researcher Steven B. Zeliadt said that there was little evidence-based consensus in the oncology community about the most effective treatment and men must still balance existing information about risks and benefits of available therapies with their own treatment objectives.

Interestingly, men's concerns about "controlling the cancer" compared directly with the aggressiveness of the treatment they chose - regardless of the actual severity of the disease. But the men did not consistently rely on scientific evidence of a therapy's effectiveness to control the disease or prolong life. Zeliadt said that as few as one-in-four patients relied on evidence of a treatment's effectiveness for their decision. Adding to the muddle, it was found that doctors tended to present therapies in ways that were both confusing and dismissive of the patients concerns about associated risks, which often resulted in patients turning to other sources of information.

Based on material from the University of Texas M. D. Anderson Cancer Center and the American Cancer Society

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