New evidence suggest that men who postpone prostate cancer treatment in favor of the active surveillance strategy may not have all the facts. A Cambridge University study found that as many as half of all men with prostate cancer receive an underestimated diagnosis about the severity of their disease. As a result, many men who believe they have less aggressive prostate cancer tumors may be putting themselves at risk for disease spread by postponing prostate cancer treatment.
Prostate cancer is often considered to be a slow growing, less threatening form of cancer. As such, many men decline definitive treatments such as robotic prostatectomy surgery or radiation. Instead, they participate in ongoing prostate cancer testing to monitor disease progression, opting to treat their cancer only when tests suggest it necessary. New York’s David B. Samadi, MD, Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital, expressed concern about the implications of the new findings for men who postpone treatment.
“The effectiveness of active surveillance depends wholly on frequent disease assessment,” said Dr. Samadi. “Without complete confidence in the results of prostate cancer tests, postponing treatment is a risky proposition,” said Dr. Samadi.
The findings, published in the British Journal of Cancer, included a total of 800 prostate cancer patients who chose to have their cancer surgically removed. More than half of the 415 men who were originally diagnosed with slow-growing prostate cancer later learned they had more aggressive disease, http://www.nature.com/bjc/journal/vaop/ncurrent/full/bjc2014192a.html
Further, 30 percent of the cases diagnosed as localized had actually spread outside of the prostate gland. Had these men postponed treatment, they might have missed the window for curative treatment.
“We’ve known for a long time that post-surgery tumor analysis is far more accurate that pre-surgery screenings,” said Dr. Samadi. “Today’s testing limitations can severely jeopardize the active surveillance approach. Results are simply not definitive until we see the prostate firsthand, remove all evidence of cancer, and conduct thorough lab testing.”
Only 24 percent of the study participants received confirmation of low risk disease from post-surgery analysis.
Despite the range of tools used to detect and diagnose prostate cancer, neither the prostate-specific antigen (PSA) blood test, the digital rectal exam (DRE), nor the prostate biopsy are without imperfections.
“Treatment decisions must be made as a collaboration between patient and prostate cancer experts, with constant acknowledgement of how limited our understanding is before surgery,” added Dr. Samadi.
As a leading robotic prostate surgery, Dr. Samadi has performed more than 5,600 successful robotic prostate surgeries to date.