"Cancer" is a very scary word, which is why being diagnosed with prostate cancer can trigger a dramatic reaction in men and doctors that can do more harm than good, new studies report.
About 1 in 7 men are diagnosed with prostate cancer in their lifetime, and it's the second-leading cause of cancer death in American men, trumped only by lung cancer. But while prostate cancer is a serious disease, most men who are diagnosed with it don't die from it, said Otis Brawley, chief medical officer of the American Cancer Society.
Brawley is urging men not to overreact when they get diagnosed with prostate cancer, and to not start jumping on treatment plans before they consider other options, including doing nothing at all.
"We have great data to show that the overwhelming majority of men with Gleason 6 tumors and low-volume disease who are watched do very well in terms of prostate cancer. This is about half of all men diagnosed with localized prostate cancer in the United States," Brawley said. "There are standards for who is a candidate for observation of prostate cancer, but most United States urologists and patients do not follow them."
Why not? It's hard to simply sit back and let yourself be observed rather than letting a doctor try to eradicate the cancer, said Eric Klein, chairman of the Glickman Urological and Kidney Institute at the Cleveland Clinic.
"Most men who are newly diagnosed with prostate cancer choose to be treated for a variety of reasons — fear of the diagnosis, uncertainty that they have a cancer that will not harm them, economic incentives for physicians for treatment rather than observation — and then they suffer the side effects of treatment without actually having needed to be cured," Klein said.
New studies found that rather than helping with the prostate cancer, treatment may do nothing, at best or is sometimes detrimental to the health of the patient.
A 2013 study by researchers at the University of Toronto found that 40 to 50 percent of patients with favorable risk prostate cancer would benefit by avoiding treatment altogether.
But because there's no firm standard in physician care when it comes to treating prostate cancer patients, it all depends on doctors, says a July study published in JAMA Internal Medicine.
The study found that of more than 12,000 low-risk prostate cancer patients, 80 percent received treatment and 20 percent were on active surveillance.
According to the study, the way a low-risk prostate cancer patient is treated varied tremendously based on the urologist he chose to see.
Another July study examined the 15-year survival outcomes following the use of primary androgen-deprivation therapy for early-stage prostate cancer, which has been widely used for localized prostate cancer despite having serious side effects, especially among older patients. The study found that it isn't associated with improved long-term overall disease-specific survival for men with prostate cancer.
"Most patients diagnosed with cancer would like to do something to treat their cancer," said Grace Lu-Yao, lead author of the study and professor of medicine at the Rutgers Robert Wood Johnson Medical School, explaining ADT's popularity despite its poor results.
"ADT appears to be a relatively simple intervention, although it has many side effects. One injection can last for 3 months, and an implant can last up to 12 months."
Overtreatment and overdiagnosis
Not only is prostate cancer being overtreated, but it's also being overdiagnosed, one study found.
Prostate cancer screening doesn't have much benefit for men who are 75 and older, for example, according to a 2013 study by researchers at the Yale Cancer Outcomes, Public Policy and Effectiveness Research Center.
But the Medicare fee-for-service program spends $447 million each year on PSA-based screening, of which one-third was for men 75 and older, the study found.
It's not just older men who are being overdiagnosed, however, said Arul Chinnaiyan, professor of pathology and urology at the University of Michigan Medical School.
Chinnaiyan said that the PSA (prostate-specific antigen) test often detects slow-growing versions of prostate cancer that won't harm an individual.
But, he said, the problem arises because doctors often can't tell which version of prostate cancer an individual has — slow-growing versus aggressive.
"Thus, we often treat slow-growing versions of prostate cancer that may not need to be treated," Chinnaiyan said.
Currently, the American Cancer Society recommends that men who are of average risk for prostate cancer and expect to live at least 10 more years start discussing getting screened for prostate cancer at around the age of 50, but those who are at high risk (black men and men who have a first-degree relative diagnosed with prostate cancer when they were younger than 65) should speak with their physician about getting screened by the time they are 45.
The early stages of prostate cancer do not have any symptoms, and symptoms only appear when the disease is too advanced for a cure, said Stacy Loeb, assistant professor of urology and population health at New York University.
Loeb explained how tricky it is to find a balance between trying to catch all the prostate cancer diagnoses in their early states while making sure that the men who are diagnosed stay calm and stick to being on active surveillance as long as they are considered low risk.
"This means deferring treatment and observing the cancer over time," she said. "If the disease worsens over time, then treatment can be offered. Otherwise, this is an important way to reduce overtreatment."
New diagnostic tools
In the future, Loeb said, doctors may also reduce overtreatment by using some newer diagnostic tests for prostate cancer.
A new version of PSA called the Prostate Health Index (PHI) was recently approved by the FDA and has become available in the U.S. The PHI, which has been available in Europe since 2010, is supposed to differentiate between prostate cancer and benign prostate conditions, and could reduce unnecessary biopsies.
"This test is more specific than PSA for detecting important cancers," she said.
Loeb, who was a co-author of a 2014 study about this new test, found that PHI, which is a simple and inexpensive blood test, consistently outperforms conventional PSA measurements.Copyright © 2015, CT Now