Men with low-risk prostate cancer apparently do not always get the best advice from their health service provider when it comes to the management and treatment of their condition.
In two separate studies published in the journal JAMA Internal Medicine on July 14, researchers found that older men with prostate cancer tend to be overtreated or given more harmful treatments that do not significantly improve their survival outcome.
In 2011, an independent panel of experts recommended to delay treatment of prostate cancer that does not likely pose long-term health risks. In place of immediate treatment, the panel endorsed active surveillance of men with low-risk prostate cancer, as studies have shown that immediate treatment and active surveillance have similar survival outcomes.
For the study "Physician Variation in Management of Low-Risk Prostate Cancer," which involved 12,068 men who were at least 66 years old and diagnosed with low-risk prostate cancer between 2006 and 2009, Karen Hoffman, from The University of Texas MD Anderson Cancer Center in Houston, and colleagues found that urologists recommend prostatectomy, brachytherapy, cryotherapy and external-beam radiotherapy. That's despite knowing that careful observation of the cancer may just be as effective as these treatments, which pose risks and unwanted side effects including rectal bleeding, impotence and incontinence.
The researchers observed that of the older men who were diagnosed with low-risk prostate cancer, 80.1 percent were given treatment while only 19.9 percent were observed. Hoffman and colleagues also noted that older doctors were more likely to recommend surgery or radiation than their younger colleagues.
"After adjustment for patient and tumor characteristics, urologists who treat non-low-risk prostate cancer and graduated in earlier decades were less likely to manage low-risk disease with observation," the researchers wrote.
Researchers of the second study "Fifteen-Year Survival Outcomes Following Primary Androgen-Deprivation Therapy for Localized Prostate Cancer," on the other hand, found that while androgen-deprivation therapy (ADT) is widely used to suppress the production of testosterone in men with early prostate cancer, their study involving over 66,000 prostate cancer patients shows that ADT does not actually extend the lives of the patients.
Study researcher Grace Lu-Yao from the Rutgers Cancer Institute in New Jersey said that while ADT is associated with a number of side effects, it only has limited evidence to support its use. She said that the therapy is not a good option for most patients with localized prostate cancer.
"Primary ADT is not associated with improved long-term overall or disease-specific survival for men with localized prostate cancer," Lu-Yao and colleagues wrote.
