For some prostate cancers, skip therapy

HACKENSACK, N.J. — For men over age 65, doing nothing to treat localized, non-aggressive prostate cancer may be the best policy, according to major new research by New Jersey scientists. Survival rates have improved to 94 percent in such cases, even with no surgery, radiation or hormone therapy.

The finding may lead to a reassessment of the treatment of localized prostate cancer in older men, as patients and doctors find reassurance that conservative management or "watchful waiting" does not result in more deaths.

The study, by researchers from the Cancer Institute of New Jersey in New Brunswick, appeared Wednesday in the Journal of the American Medical Association.

It found that men older than 65 diagnosed since 1992 with mild or moderately aggressive prostate cancer had only a 2 percent to 6 percent chance of dying from the cancer, compared with death rates of 15 percent to 23 percent in the 1970s and 1980s without treatment. The difference may be due to earlier diagnosis, over-diagnosis as a result of PSA testing or advances in medical care, the study said.

The PSA test, or blood test for prostate-specific antigen, detects prostate cancer six to 13 years before it is found clinically.

"Outcomes following conservative management are now significantly better than those reported in previous eras," the study said. "Physicians and their patients may need to reconsider this management option."

Until now, only 10 percent of men over 65 have followed the course of conservative management, despite side effects from treatment that can include impotence and incontinence.

Men diagnosed with prostate cancer face a bewildering decision about treatment options that include surgical removal of the prostate, radiation — either from an external beam or internal implants of radioactive seeds — and hormone therapy to suppress androgens, which stimulate the growth of prostate cancer cells.

"For the majority of patients, their cancer is not that aggressive. They need to balance and weigh the side effects," said Grace Lu-Yao, a cancer epidemiologist at the Cancer Institute of New Jersey and the lead author of the study.

"A lot of men over 75 have radiation, which has a lot of side effects," she said. "For that age group, watchful waiting or conservative management is a reasonable decision."

The results of the study do not apply to men younger than 65, or to those with more aggressive types of prostate cancer, who should be treated.