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Major study finds most older men will die of other causes
By Amanda Gardner
Posted 2/13/08

WEDNESDAY, Feb. 13 (HealthDay News) -- One of the largest studies of its
kind concludes that most older men with early prostate cancer do not
shorten their survival odds if they adopt a "wait-and-see" approach to the
disease.

In fact, most such patients will die of other causes or they simply won't
develop any complications from the cancer, the researchers found.

"Many elderly men with lower risk cancer may do well with conservative
management," concluded study author Grace Lu-Yau, a cancer epidemiologist
at the Cancer Institute of New Jersey, and an associate professor at
UMDNJ-Robert Wood Johnson Medical School and School of Public Health.

"Each patient facing a treatment decision has to ask himself what is the
potential survival benefit of various treatments and the potential side
effects of various treatments, then compare this potential risk of side
effects with the potential risk of cancer complications if the cancer is
left untreated -- and ask themselves which treatment option is their
personal preference," Lu-Yau said.

She presented the findings to reporters at a special teleconference
Tuesday, part of the 2008 Genitourinary Cancers Symposium taking place in
San Francisco.

The question of whether to treat or not treat prostate cancer has long
absorbed experts.

Although one in six men in the United States will be diagnosed with
prostate cancer in their lifetime, many of the malignancies are
slow-growing, and there is currently no reliable way to identify which men
will benefit from treatment. Better knowledge of the natural history of
the disease (i.e., what happens without any treatment) would help guide
treatment decisions, Lu-Yau said.

This study is one of the first to look at the natural history of prostate
cancer since PSA (prostate-specific antigen) blood testing has become
commonplace. PSA tests can detect a prostate cancer six to 13 years
earlier than previous methods.

Lu-Yau and her colleagues looked at data on more than 9,000 men with Stage
I or II prostate cancer diagnosed between 1992 and 2002 who did not
undergo treatment. The mean age of participants was 77 years.

Seventy-two percent of these men died of other causes or didn't have
enough cancer progression to warrant surgery or radiation, the researchers
found. For the remaining 2,675 men who did receive treatment, the median
time between diagnosis and start of therapy was more than 10 years.

Not surprisingly, men with less aggressive disease survived longer than
those with more aggressive tumors.

"For elderly men with localized prostate cancer, the potential survival
benefit for treatment is most likely modest, therefore it is very critical
to weigh the risk of having side effects of various treatments with the
risk of developing cancer-related complications down the road," Lu-Yau
said. "The majority of patients will die of other causes or remain alive
without significant major complications."

A second study presented at the conference found that giving salvage
radiation therapy (SRT) to men whose PSA levels rise after having their
prostate removed can reduce their risk of dying from the cancer by more
than 60 percent.

SRT is typically given only after a recurrence, not after an initial
diagnosis of prostate cancer, noted study lead author Dr. Bruce Trock,
associate professor of urology, epidemiology, oncology and environmental
health sciences at Johns Hopkins University School of Medicine in
Baltimore. Existing studies have either not been large enough or long
enough in duration to determine if SRT prolongs survival.

In this retrospective analysis of 635 men who had experienced a recurrence
after having their prostate removed, 62 percent of those who did not
receive any salvage therapy were still alive after 10 years, versus 86
percent of those who received SRT and 82 percent of those who received SRT
plus hormone therapy.

Men whose PSA doubling time (the amount of time it took for PSA levels to
double from when in first becomes detectable) was six months or less had
the greatest benefit.

"If another study was able to replicate our data, it could lead to
clinical trial that would eventually support a way to determine who should
get immediate adjuvant radiation and who could wait until the time of
recurrence to have SRT," Trock said. "The question is, could a benefit be
achieved in some of these men if you waited to see whether they recurred
or not?"

More information

There's more on prostate cancer at U.S. National Cancer institute.
http://www.cancer.gov/cancertopics/types/prostate

http://www.cancer.ca/ccs/internet/mediareleaselist/0,,3172_1613121606_339367_lan
gId-en.html

The START clinical trial
The study will take place in approximately 100 study centres in Canada,
the
United States and England.

Why is this clinical trial important?

With funding from the Canadian Cancer Society, the START clinical trial
will
answer one of the thorniest questions in prostate cancer today – whether
or
not, and when, to start aggressive treatment.

More specifically, it will determine if all newly-diagnosed patients with
favourable risk cancer need to be treated with surgery or radiation when
they
are initially diagnosed or if most of these patients can be monitored
closely
and treated only if necessary.