Prostate Cancer: Wait or Treat?
Recommendations may depend on age, health and tumor characteristics

(HealthDay News) -- There's no one-size-fits-all solution for prostate cancer, especially for men 65 and older.

Today, in fact, there's good scientific evidence to support an older man's decision to either observe the cancer closely or seek aggressive treatment.

"Patients should understand the risks and benefits of all their treatment options -- radiation, surgery and observation," Dr. Yu-Ning Wong, a medical oncologist at the Fox Chase Cancer Center in Philadelphia, told HealthDay.

Prostate cancer is the most common cancer in men, other than skin cancer. By the end of 2009, an estimated 192,280 new cases of prostate cancer will have been diagnosed in the United States, by American Cancer Society predictions. More than 27,000 men will have died from the disease in 2009.

The type of treatment a man receives depends on a number of factors, according to the National Comprehensive Cancer Network. These include his age and general health as well as the characteristics of his tumor.

Researchers in one study found that older men who choose "watchful waiting" are experiencing better survival rates today than in prior decades, before prostate cancer screening became prevalent.

Researchers in New Jersey and Massachusetts evaluated data on 14,516 men who were 65 and older when they were diagnosed with cancer, between 1992 through 2002. All of the men had cancer that was caught before it had spread to other parts of the body.

For six months after diagnosis, the men were managed without surgery or radiation.

The risk for dying from prostate cancer over a 10-year period after diagnosis declined by more than 60 percent, compared with men diagnosed in the 1970s and 1980s, the study found.

However, an argument also can be made for more robust intervention.

Researchers at the University of Pennsylvania followed 44,000 men, 65 to 80 years old, who were diagnosed with prostate cancer between 1991 and 1999. Men with more aggressive cancers were excluded from the study.

Men who chose to have either a radical prostatectomy or radiation therapy within six months of being diagnosed were 30 percent less likely to die in the next 12 months than were those who did not undergo treatment within six months of diagnosis.

Both studies were published in the Journal of the American Medical Association.

Because each person's situation is unique, the cancer experts urge men to discuss treatment options with their doctor. Questions to ask include:

• How do my age, general health and other medical conditions affect my treatment choices?
• What stage is my cancer, and how does that influence my treatment options?
• How do my Gleason score (a system of grading prostate cancer tissue to indicate the likelihood that it will spread) and my blood prostate-specific antigen (PSA) level determine my outlook for survival and affect treatment options?
• What are the side effects of each treatment, and how will they affect my quality of life?
• What can be done to help manage the side effects of treatment?

On the Web

To learn more about treating prostate cancer, visit the U.S. National Cancer Institute.

SOURCES: HealthDay News; Yu-Ning Wong, M.D., medical oncologist, Fox Chase Cancer Center, Philadelphia; Dec. 13, 2006, and Sept. 16, 2009, Journal of the American Medical Association; University of Medicine and Dentistry of New Jersey, news release, Sept. 15, 2009; American Cancer Society, Atlanta; National Comprehensive Cancer Network, Fort Washington, Pa.
Author: Karen Pallarito
Publication Date: Nov. 30, 2009
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