Treating Prostate Cancer

In this blog entry I will be exploring the survival advantages for prostate cancer such as age.

The U.S. Services Preventative Task Force, in May of this year, issued a recommendation to urologists and oncologists in the U.S. that routine PSA testing. This basically means that screening an asymptomatic population probably is not worthwhile. They issued this recommendation on the basis that there isn’t any evidence that, for many patients having definitive treatment for prostate cancer that there is a survival benefit.

What we’ve know for a long time that the patients who are elderly, who have a low-risk prostate cancer; in other words, one that’s likely to be slow-growing, there isn’t a significant survival advantage. And that isn’t new news. We’ve known this since Peter Albertsen produced his survival charts looking at cancer-specific survival versus time over a 12-year period.

We know that for patients with more-aggressive tumors, or intermediate and high-risk prostate cancer, and also for patients who are younger, there is definitely a survival advantage.  There is also definitely an improvement in their overall health for a longer period of time if they are treated definitively.

So, the conclusion, really, is that patients who are elderly with low-risk prostate cancer may not need any form of treatment. But this does not apply to younger patients and for patients with more aggressive cancers who still need to have definitive treatment.

The reality is, in the U.K. alone, 35,000 men are diagnosed with prostate cancer a year and 10,000 men a year die of prostate cancer.  That is roughly one man per hour. So about a third of patients with prostate cancer diagnosed are dying. This is a potentially lethal condition and men do need treatment, but not all men need treatment.

Almost certainly, we’re undertreating high-risk prostate cancer; or patients with a Gleason grade of 8 or above or a PSA of 20 or above. But we are over-treating low-risk prostate cancer and most of these patients would be better off on an active surveillance program, only having intervention if they have evidence of disease progression.