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Brendon Nafziger, DOTmed News Associate Editor | July 27, 2010
Of note, around 66 percent of men between the ages of 65 and 74 with low-risk disease and a low PSA value received aggressive treatment, even though ongoing research suggests men older than 65 with low-risk disease treated with prostate removal don't do better than those undergoing conservative management, the authors said.
"These findings suggest that many contemporary men receiving treatment for localized prostate cancer are unlikely to benefit from the intervention," the authors wrote.
Another curious finding, which the researchers say they don't have enough information to explain, is that men whose prostate cancer was detected after a routine screening and who had low PSA values were almost one and a half times more likely to receive aggressive treatment than those whose cancer was diagnosed after reports of symptoms or for other causes.
The reason? "[It's] hard to know," Stein said.
The authors said if the threshold for biopsy dropped from 4 to 2.5 nanograms per milliliter, the number of men getting biopsies could double to 6 million. Of these men, about 32 percent would be diagnosed with prostate cancer after needle biopsy.
"Based on the results in the present study, 82.5 percent of these 1.9 million men would receive attempted curative treatments, while only 2.4 percent would have high-grade cancer," the researchers wrote. "However, no evidence suggests that delaying biopsy until the PSA level reaches 4.0 nanograms per milliliter would result in an excessive number of potentially non-curable disease cases."
Nonetheless, Stein warns that researchers haven't figured out whether the risks of over-treating low-risk prostate cancer actually outweigh the risks of missing early cancers. In the study, the authors note that the relative five-year survival rate for all stages of prostate cancer climbed from 69 percent to almost 99 percent in the last three decades, and this could partly be due to finding cancers earlier through screening programs.
"We really need to understand who truly is at low risk," Stein said.
To that end, Stein said a massive joint Canada-United States study currently underway is investigating health outcomes for men with favorable cancer diagnoses treated with active surveillance.
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