Safe to skip radiation for prostate cancer?

Jun 7, 2011, 9:25 a.m.

By Alison McCook

NEW YORK (Reuters Health) - A review of recent studies comparing different radiation treatments for prostate cancer reveals no clear picture of what works best for the majority of men with the disease.

Unlike many other cancers, prostate cancer often grows slowly and may never progress to the point where it threatens a man's life. This complicates treatment decisions, because therapies for prostate cancer carry risks -- including long-term urinary incontinence and erectile dysfunction. So for many men, treating the disease could potentially do more harm than good.

As a result, experts are increasingly calling for expanded use of active surveillance, sometimes called watchful waiting, in managing prostate cancer. This can mean regular blood tests, visits to a urologist, and repeat biopsies, for example.

However, no large studies have done a sufficient job of comparing what happens to men who opt for active surveillance and those who receive radiation right away, making it difficult for doctors to give sound advice about the safety of holding off on radiation therapy, study author Dr. Raveendhara Bannuru at Tufts Medical Center told Reuters Health. "We had insufficient evidence to give any specific recommendations on that."

The lack of a conclusion was not a surprise to Dr. Peter Albertsen of the University of Connecticut Health Center in Farmington, who reviewed the findings for Reuters Health. In previous studies, prostate cancer patients who chose to forgo radiation were often "fundamentally different" from those who chose treatment - they were generally healthier or their cancer was less aggressive, for instance - which makes comparisons between the two difficult, he said.

As a result, for the majority of men who are faced with the choice, the main option is to speak with their doctors, radiation therapists, and surgeons, then "go back and try to decide what's right for you," Albertsen told Reuters Health.

"Decisions regarding treatment choice for localized prostate cancer should always be a shared decision between the patient and his physician," agreed Dr. Timothy Daskivich of the University of California, Los Angeles, who also reviewed the findings for Reuters Health.

Prostate cancer is the most common cancer among U.S. men. One in six will eventually develop it.

The advent of prostate cancer screening with blood tests for PSA (prostate-specific antigen) has meant that a large number of men are now diagnosed with early stage cancer that's unlikely to ever become life-threatening. Indeed, most men are diagnosed with a localized form of the disease, meaning it has not spread throughout the body.

Recently, researchers have been finding that it may be okay for some men to skip treatment. Last year, researchers found that among 466 patients who chose active surveillance rather than immediate treatment, those with tumors at intermediate risk for progression fared as well as men with low-risk prostate cancer over four years. Earlier this year, Albertsen and his colleagues found that option may be safe even for some older men with riskier forms of the disease.

In the current study, published in the Annals of Internal Medicine, Bannuru and his colleagues reviewed 75 studies that looked at the benefits of different types of radiation therapy in prostate cancer, and the risks of skipping it altogether.

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