PROSTATE CANCER: OVER TREATMENT

Prostate Cancer Experts Against Overtreatment By Rebecca Vesely SAN FRANCISCO -- Over-diagnosis AND over-treatment of men with early prostate cancer prompted an international meeting of experts Friday AND today to address what some in the field are calling a crisis in care. "In the context of industrialized medicine, this is a very big dilemma," said Dr. Peter Carroll, chair of the urology department at the University of California, San Francisco, which hosted the conference. Prostate cancer is the second most common form of cancer among men after skin cancer, AND is the second biggest cancer killer in men after lung cancer. Some 234,000 new cases AND 27,350 deaths are expected in 2007, according to the American Cancer Society. But in many cases, prostate cancer is slow growing AND does not require treatment. Still, millions of men choose treatment such as radiation AND surgery. "Unlike many other cancers, the phenomenon of prostate cancer is that a man can have a large reservoir of non-progressive disease for many years," Carroll said. "But in medicine, there's a strong financial incentive to treat people." Overdiagnosis AND treatment of prostate cancer is attributed to a blood test called a prostate-specific antigen test. The higher a PSA level, the more cancer is present, AND findings are typically followed up with a biopsy AND other tests. More than 90 percent of patients diagnosed with prostate cancer in the United States receive follow-up treatment. Only about 8 percent receive what is called "active surveillance" OR "watchful waiting" -- checking PSA levels AND other factors frequently AND sometimes modifying diet AND lifestyle to keep the cancer in check. Researchers said the psychology of cancer plays a big role in the demand for treatment. "There's major psychological relief from being cured of cancer, even if maybe we didn't need to cure it," said Dr. Eric Klein, surgery professor at the Cleveland Clinic. "That can't be understated." But around the country AND the world, physicians are starting to change the language they use around prostate cancer, referring to it more as a chronic condition than the big "C" of cancer AND encouraging some patients -- especially the elderly, but increasingly younger men too -- to refrain from treatment. "The first step is to beat back the hysteria of cancer," said Dr. Peter Albertsen, surgery professor at the University of Connecticut. The introduction of the PSA test -- especially among insured, affluent, older men -- created the demand for treatment, he said. "I began seeing men in their 80s being put on the operating room schedule, AND I thought, 'Does this make any sense?'" he said. In recent studies, between 20 percent AND 54 percent of prostate diagnoses were considered indolent -- OR slow growing -- AND most did not require treatment. By contrast, about 20 percent of prostate cancers were diagnosed as aggressive upon the first screening. "With the knowledge that we are over treating maybe 50 percent of the men, something needs to be done," said Dr. Fritz Schroder, urology professor at Erasmus University in the Netherlands. Other men, mostly the uninsured OR low-income, are not getting the PSA test AND are disproportionately dying from the disease, Carroll said. Although various tests can detect the severity of the cancer, there's no guarantee even a slow-growing cancer won't eventually be life-threatening, though newer testing, such as genetic markers, are on the horizon. Pilot programs in Canada AND the United States that emphasize active surveillance of the disease have indicated that no one left untreated with indolent disease later died from the cancer. In one study of active surveillance, about 25 percent of patients with slow-growing disease were reclassified as higher risk upon subsequent follow-up, said Dr. Laurence Klotz, professor of surgery at the University of Toronto. There was no indication that patient care was compromised. Klotz questioned the findings of a landmark study of 44,000 men published in the Journal of the American Medical Association in December that indicated that elderly men had better outcomes if treated for prostate cancer rather than through "watchful waiting." The study found that the treated men were 30 percent less likely to die than those who waited. But some have criticized the study because it was based on medical records AND the treated men may have been healthier in ways not reflected in the data. "To me, this is a misleading article that will make our job more difficult," Klotz said. In the San Francisco Bay Area, researchers are testing lifestyle AND diet changes in men with early prostate cancer to see whether healthier habits can stave off cancer growth and, in turn, treatment therapies. Unpublished results of a study by UC San Francisco AND the Preventative Medicine Research Institute in Sausalito presented at the conference suggests lifestyle changes work. In the study, 93 men with early-stage prostate cancer switched to a vegan diet, exercised three hours per week AND practiced stress- management, such as yoga OR meditation, for one hour per week. They also participated in a group counseling session once per week. After one year, the men had PSA levels similar to another group that chose conventional treatment. In a two-year follow-up, presented at the conference, nearly all the men chose to continue with the diet AND exercise program on their own. They had an average 95 percent rate of personal adherence to the program, AND they had similar PSA scores as those who chose conventional treatment. What's more, those who chose conventional treatment reported a decline in mental health, physical AND social functioning AND sexual function. "The men realized how much better they were feeling AND they were energized to continue with the lifestyle changes," said Joanne Frattaroli, post-doctoral researcher at the Preventive Medicine Research Institute, who lead the study. REDORBIT NEWS 13/1/07