Doctors worry patients may get the wrong idea about what's
effective
by Stephanie
Thurrott | December 14, 2018
A study published Wednesday in the New England Journal of Medicine
found that certain men with prostate cancer lived 2.9 years longer if they had
their prostate removed, compared to men with “watchful waiting” as their
treatment.
Both the study and
coverage of it has alarmed doctors who fear it will be misinterpreted.
“My fear is that
someone will read a headline that says that surgery improves outcomes for
prostate cancer as opposed to watchful waiting,” says Len Lichtenfeld,
MD, interim chief medical and science officer for the American
Cancer Society.
The research is
noteworthy because it starts back in 1989, so scientists studied the earliest
participants for 29 years.
“Following people for
25 to 30 years is not something that’s reported very often,” Litchfield says,
adding that while it’s interesting it “clearly should not be interpreted to
mean that surgery is better than watchful waiting.”.
His main fear:
“I’d be very concerned if someone with a diagnosis read this and said, ‘I want
surgery instead of watchful waiting’.”
29 years is a long
time
There’s nothing
inherently wrong with the study. But the length of time since it began makes it
problematic when it comes to deciding on treatments now.
“Trying to compare
this study to what is done in the U.S. today is not really a reasonable
comparison,” Lichtenfeld says. “It’s an entirely different world today in terms
of how we diagnose and treat cancer.”
When the study
started, most men were diagnosed with prostate cancer in one of two ways. They
noticed symptoms like trouble urinating, blood in the urine or semen, or
erectile dysfunction. Or, their doctor felt a mass during a rectal exam.
Those signs and
symptoms typically come along once prostate cancer is relatively
advanced.
Today, most cases are
discovered much sooner thanks to prostate-specific antigen (PSA) screening, a
blood test that can identify prostate cancer well before symptoms or masses
appear. It was FDA approved as a screening test beginning in 1994.
A good option
Now, most men with
small, low-grade cancers can be watched and tested periodically. That’s because
prostate cancer tends to progress slowly—so slowly that most men who have it
die of something else.
That was true even
among the research participants—80% died within the study’s 29 years, and 68%
of them died from causes other than prostate cancer.
It’s important to
note that watchful waiting doesn’t mean surgery won’t ever be necessary.
Changes in PSA levels or other concerns might make surgery a viable option at
some point for men with prostate cancer. But today, surgery is less likely to
be a first-line treatment for most men.
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