Are Too Many Prostate Cancer Patients Receiving Treatment?

Study also raises concerns about possible overuse of radiation therapy

Thursday, February 19, 2015

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THURSDAY, Feb. 19, 2015 (HealthDay News) -- New research suggests that a wait-and-watch approach for prostate cancer isn't being used often enough, and that more men are being treated than may be necessary.

Additionally, the researchers expressed concern about the numbers of men being treated with radiation therapy, regardless of their tumor specifics.

"Too many men are being treated for prostate cancer, and too many are being treated with radiation therapy," said study lead author Dr. Karim Chamie, an assistant professor of urology at the University of California, Los Angeles.

But, the researchers weren't able to tease out clear reasons why these things might be happening.

The study appears in the Feb. 19 online edition of the journal JAMA Oncology.

Prostate cancer can often be detected early, and according to the researchers, as many as 233,000 men in the United States are diagnosed with the disease every year. Some of these cancers need to be treated immediately, while others can be watched over time to see how the cancer develops. This is known as active surveillance.

Prostate cancers often fall into a category known as indolent -- this means the cancer generally won't cause problems or isn't expected to be life-threatening, according to background information in the study. Active surveillance may be an option for these cancers.

Because some prostate cancers will never cause a problem, and treatments -- such as radiation or surgery to remove the prostate -- can cause significant side effects, experts have been debating which patients need treatment and who can wait, the study authors explained. Prostate cancer treatments can cause severe side effects such as difficulty urinating and impotence.

Chamie said a better option to treatments in many cases is to monitor patients over time to see if their prostate cancer worsens.

In the new study, the researchers aimed to figure out why many men don't choose that option.

The investigators tracked almost 38,000 men in the United States who were diagnosed with prostate cancer between 2004 and 2007. The researchers followed the men, who were all at least 65 when diagnosed, through 2009.

Only 10 percent of those diagnosed chose to forgo treatment, at least temporarily, the study found. Almost 58 percent of the men chose radiation therapy while 19 percent had their prostate removed.

The researchers said that the men who underwent radiation got treatment regardless of the severity of the disease. When it comes to radiation, Chamie said, "patient factors contribute very little to the decision-making process."

Chamie said financial incentives for doctors might play a role in the preference for radiation, especially since reimbursement for radiation is higher than for surgery.

Dr. Sandip Prasad, an assistant professor of urology at the Medical University of South Carolina, who co-wrote a commentary in the same issue of the journal, didn't go as far as to say that radiation is overused. Still, he said, "we believe treatment -- radiation or surgery -- shouldn't be 90 percent of what's being done."

The study only looked at older men, so researchers don't know if these trends are the same in younger men. The study also didn't ask patients why they made the choices they did. In addition, the researchers didn't gather information on survival so they don't know if radiation or surgery helped more than expected in the long run.

Might things be different now, a decade or so after these men were diagnosed? It's possible, Chamie said, with perhaps 20 percent of patients choosing to be monitored instead of 10 percent. "But the most common treatment will still be radiation," Chamie added.

Prasad said it can be difficult to convince patients to not act to treat their prostate cancer.

"Sometimes you almost have to sell it to the patient," he said. "Their innate instinct is to treat that cancer. The reality is that for prostate cancer, there are typically a number of excellent options. Unfortunately, we still don't know the key factors that push patients toward the choices they make."

SOURCES: Karim Chamie, M.D., assistant professor of urology, University of California, Los Angeles; Sandip Prasad, M.D., assistant professor of urology, Medical University of South Carolina, Charleston; Feb. 19, 2015, JAMA Oncology, online

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