Men with low-risk prostate cancer may wait to see if their disease progresses before treating it, an independent panel of experts convened by the U.S. National Institutes of Health (NIH) said on Wednesday.
The panel backed the so-called active monitoring approach to prostate cancer treatment as a way to help men avoid the potential health consequences of treatment, which include impotence and incontinence.
The NIH is considering dropping the name "cancer" from this very early stage of the disease because it may make it easier for men to accept that carefully monitoring for changes is a better approach for them than immediate treatment.
Prostate cancer is the most common non-skin cancer in men in the United States. Some 240,000 U.S. men will be diagnosed with prostate cancer this year, and about 33,000 will die of the disease. More than half of these cancers are confined to the prostate and unlikely to become life-threatening.
Even so, about 90 percent of men who are diagnosed with prostate cancer get immediate treatment, such as surgery or radiation therapy.
"It's clear that many men would benefit from delaying treatment," said Dr. Patricia Ganz, a cancer prevention expert at the University of California Los Angeles, who chaired the NIH's state-of-the-science panel on prostate cancer.
The problem, said Ganz, is there is no consensus on the best strategies for monitoring the progress of prostate cancer and what benchmarks should be used to determine when treatment is needed. The panel urged NIH for more research to clarify this matter.
Many doctors already use a variety of monitoring strategies for men whose low-grade prostate cancer was detected through PSA screening, a blood test that detects levels of a protein made in the prostate gland known as prostate-specific antigen.
Elevated levels of this protein can indicate prostate cancer, but it can be caused by other things as well..
Several studies have suggested many men are over-screened for prostate cancer, and this over-screening has in many cases caused more harm than good, leading men to chose a biopsy and treatment for a slow-growing cancer that may have never caused them harm during their lifetimes. Alternative strategies for men with low-risk prostate cancer typically fall into two camps: observation with and without the intent to cure.In the observation without intent to cure approach, sometimes called watchful waiting, doctors treat symptoms if they develop.
In observation with intent to cure, often called active surveillance, patients undergo frequent testing and are offered curative treatment if the cancer progresses.
Ganz said it is not yet clear which approach is best.
"Prostate cancer affects some 30-40 percent of men over the age of 50. Some of these men will benefit from immediate treatment, others will benefit from observation. We need to standardize definitions, group patients by their risks and conduct additional research to determine the best protocols for managing low-risk disease," she said in a statement.