Low-Risk Prostate Cancer Outcomes Similar With Observation or Radiation
Therapy

By Will Boggs, MD

NEW YORK (Reuters Health) Aug 19 - Among men with nonmetastatic prostate
cancer, distant metastases and survival rates are virtually the same
after 3-dimensional conformal radiation therapy (3-DCRT) or with a
watchful waiting strategy, according to a report in the July BJU
International.

"Observation is an option for men with nonaggressive prostate cancer who
are older or have other medical co-morbidities," Dr. Eric M. Horwitz
from Fox Chase Cancer Center, Philadelphia, Pennsylvania told Reuters
Health.

Dr. Horwitz and colleagues compared outcomes in two matched groups of
men with nonmetastatic prostate cancer: 69 who were observed because of
indolent disease, significant medical comorbidities, or refusal of
treatment, and 69 who were treated with 3-DCRT.

Five-year and 8-year actuarial survival was 94% and 73% with observation
and 95% and 75% with 3-DCRT (p=0.92), the authors report.
Cancer-specific survival was 100% in both groups.

The 5-year and 8-year rates of freedom from distant metastases were 100%
and 93% with observation, the researchers note, compared with 95% and
95% after 3-DCRT (p=0.54).

Four of the patients in the observation group eventually underwent
definitive 3-DCRT and fared well. "The main reasons for recommending
discontinuing observation in the present patients included increasing
PSA values and local progression of disease, as determined by digital
rectal examination," the report indicates.

"Treatment options for men with low-risk prostate cancer include
surgery, intensity modulated radiation therapy (IMRT), or a permanent
I-125 prostate implant," Dr. Horwitz said. "What we recommend depends on
a patient's age and health."

If patients are healthy and have a life expectancy greater than 10
years, "we recommend treatment," Dr. Horwitz added. "If they have
significant medical co-morbidities and/or advanced age and a low-risk
cancer, we sometimes recommend observation. If a patient has a
clinically significant prostate cancer, even if they are older or have
other medical problems, we would recommend some form of treatment."

BJU Int 2004;94:59-62.
© 2004 Reuters Ltd