When Treating Prostate Cancer, Less May Be More

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BY DAVID BRYANT, M.D. at Chalmers Cancer Treatment Center

Prostate cancer is the third most common cause of death from cancer in men of all ages. It is the most common cause of death from cancer in men over age 75. It is rarely found in men younger than 40.

Prostate cancer starts in the prostate gland, a walnut-size structure that makes up part of a man’s reproductive system. It wraps around the urethra, the tube that carries urine out of the body.

Prostate cancer treatment will depend on what kind of cancer cells you have, how far they have spread, your age and general health, and your preferences. You and your doctor may decide to treat your cancer in one or a combination of ways: hormone therapy, radiation therapy, surgery or watchful waiting, known as surveillance.

Several articles have been written in recent months about the treatment of prostate cancer. The results of these studies should change the standard of care for those dealing with prostate cancer.

Alternatives To Surgery

The Prostate Testing for Cancer and Treatment trial, published in the New England Journal of Medicine, looked at the benefit of screening and treating men with mostly low-risk prostate cancer. In this randomized trial, more than 82,000 men ages 50 to 69 were screened with a prostate-specific antigen blood test. Out of that group, 2,664 men had prostate cancer. Of that group, 1,643 men with mostly low-risk cancer were randomized to have surgery, radiation or active surveillance.

After 10 years of follow-up, researchers found there was no difference in outcomes among those who had surgery, radiation or surveillance.

Researchers determined:

▪ There was a low risk of dying from prostate cancer.

▪ 50 percent of the men on active surveillance ended up getting treatment.

▪ Surgery for prostate cancer had more side effects than for those having active surveillance or radiation treatments.

The main takeaway from this study is that the risk of dying from low-risk prostate cancer is very low in patients who are screened, so active surveillance is a very good option. Surgery used to be the standard of care, but now radiation will be a second standard option.

Reducing Radiation

The next few studies that have recently been published look at reducing the number of radiation treatments.

In the past, people have gotten on average 37 to 48 treatments when receiving radiation for prostate cancer. The recent studies have compared the longer course of radiation to two types of shorter radiation.

One type is called hypofractionated radiation, in which a patient receives between 19 and 27 treatments.

Recent studies have shown that the shorter course of radiation works just as well as the longer courses of radiation.

The other type is called extreme hypofractionated radiation, in which a patient receives five treatments. The preliminary five- to eight-year results are very promising and may lead to a new standard of care.

Courtesy of The Wichita Eagle