Many low-risk prostate cancer patients receive aggressive treatment

Prostate cancer patients who are at low risk still undergo aggressive treatment, according to a study published in the Archives of Internal Medicine (2010;179(14):1256-1261).

According to background information provided in the paper, more than 90% of all prostate cancers are diagnosed before the disease has spread to other parts of the body, and the 5-year survival rate for these patients diagnosed with localized disease is almost 100%.

Using data from the Surveillance, Epidemiology and End Results system, a research team led by Yu-Hsuan Shao, PhD, of the Cancer Institute of New Jersey, New Brunswick, investigated current risk profiles and treatment patterns of men with prostate cancer and prostate-specific antigen (PSA) levels below this threshold. Researchers reported that of 123,934 men with newly diagnosed prostate cancer from 2004 to 2006, 14% had PSA levels of 4 nanograms per milliliter or lower.

The results of the study revealed that despite their lower risk of having clinically significant disease, treatment rates for men with PSA values of 4.0 nanograms per milliliter or lower were similar to those of men presenting with PSA values between 4.0 and 20.0 nanograms per milliliter. Specifically, radical prostatectomy was performed on 44% of men with PSA values of 4.0 nanograms per milliliter or lower, 38% of men with PSA values between 4.1 and 10.0 nanograms per milliliter, and 24% of men with PSA values between 10.1 and 20.0 nanograms per milliliter.

“Based on the results in the present study, 82.5% of these 1.9 million men would receive attempted curative treatments, while only 2.4% would have high-grade cancer,” the authors noted.

“These results underscore the fact that PSA level, the current biomarker, is not a sufficient basis for treatment decisions,” the authors conclude. “Without the ability to distinguish indolent from aggressive cancers, lowering the biopsy threshold might increase the risk of overdiagnosis and overtreatment.”

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