Michigan Cancer Consortium - Featured Activity - University of Michigan Researchers Publish Early-Stage Prostate Cancer Treatment Paper

More than half of men with lower-risk prostate cancer received surgery or radiation treatment when a wait-and-see approach of no therapy and active surveillance would have been a reasonable option, according to a new study from the University of Michigan Comprehensive Cancer Center.

For men with less aggressive prostate cancers, the balance between the risks and benefits of immediate treatment with surgery or radiation are not always well-defined. Research has shown that older men with lower-risk prostate cancer who choose so-called watchful waiting are likely to die from another cause during the first 20 years after their cancer diagnosis. Meanwhile, surgery or radiation to treat prostate cancer can lead to complications, such as erectile dysfunction, urinary incontinence, and bowel difficulties.

"Just as a failure to treat a potentially lethal prostate cancer is generally considered inappropriate from a quality-of-care perspective, overtreatment of lower-risk cancers is also not in the patient’s best interest. For some men with early stage prostate cancer, surgery or radiation therapy may result in substantial negative effects without a survival benefit," says study author John T. Wei, MD, MS, associate professor of urology at the University of Michigan Medical School.

The study findings, entitled "Incidence of Initial Local Therapy Among Men with Lower-Risk Prostate Cancer in the United States," appeared in the Aug. 16, 2006 issue of the Journal of the National Cancer Institute.

Researchers looked at 64,112 men diagnosed with early stage prostate cancer, using the Surveillance, Epidemiology and End Results registry, a population-based cancer registry maintained by the National Cancer Institute. Men were divided into high-risk or low-risk categories, based on characteristics of their tumors. Among the 24,835 men with lower-risk cancers, 55 percent were treated with initial surgery or radiation, suggesting that aggressive treatment is quite common, even among men for whom an expectant approach is a viable option.

The researchers found that, among men with lower-risk cancers, those under age 55 were more likely to be treated with surgery versus watchful waiting. In contrast, men aged 70-74 were more likely to be treated with radiation, rather than watchful waiting. From 2000 through 2002, more than 13,000 men with lower-risk cancer received treatment with surgery or radiation within the first several months after diagnosis. Among this group, patients older than 70 with mid-grade tumors were most likely to receive potentially unnecessary surgery or radiation within the first year after diagnosis.

"There are many men with prostate cancer who will benefit from early treatment with surgery or radiation therapy. However, prostate cancer is not a one-size-fits-all condition, and we now know that many men are diagnosed with slowly growing cancers that are unlikely to cause symptoms or be fatal.

"Given that the average patient often has bothersome side effects of surgery or radiation, it is important to evaluate the barriers to greater use of expectant management approaches, including active surveillance, particularly among this reasonably large group of men with lower-risk cancers," says lead study author David C. Miller, MD, MPH, adjunct lecturer at the University of Michigan and now a health services research and urological oncology fellow at the David Geffen School of Medicine at UCLA.

"Based on data from this study, it is clear that the number of lower-risk patients who receive initial aggressive therapy is not trivial, and we have to ask the question whether this is too much treatment for some of these men," Miller continues. "We should continue to explore our patients’ preferences regarding the different treatments for early-stage prostate cancer and better educate them about the entire spectrum of options, including the appropriateness of initial active surveillance in many lower-risk cases."

The authors report that for many men with lower-risk cancers, a potentially appealing treatment option is called active surveillance. Building on the traditional concept of watchful waiting, active surveillance involves frequent monitoring of the tumor without immediate active treatment. Active surveillance can help distinguish between more-aggressive and less-aggressive cancers, thereby improving doctors' ability to identify the patients most likely to benefit from surgery or radiation.

Some 234,000 men will be diagnosed with prostate cancer this year, and 27,350 will die from it, according to the American Cancer Society.

In addition to Drs. Wei and Miller, University of Michigan study authors include: Stephen B. Gruber, MD, PhD, associate professor of internal medicine, epidemiology and human genetics; Brent K. Hollenbeck, MD, assistant professor of urology; and James E. Montie, MD, Valassis Professor of Urologic Oncology and chair of urology.

The National Institutes of Health provided funding for the study.

National Publicity
Corresponding author John T. Wei, MD, MS, a member of the MCC Advisory Committee on Prostate Cancer and the MCC Prostate Cancer Action Committee, was featured in an Aug. 15, 2006 ABC World News report. ABC estimates that 8 million people nationwide view the ABC World News program each weekday.

Dr. Wei also was quoted in an Aug. 28, 2006 article by Associated Press health and medical writer Lauran Neergaard. The Associated Press syndicated article, entitled "Low-Risk Prostate Cancer Poses Dilemma," featured the University of Michigan study findings and also included information about the Michigan Cancer Consortium's www.prostatecancerdecision.org Web site. Dr. Wei served as one of the prostate cancer experts who helped the Consortium develop the Web site, which offers educational materials for early stage prostate cancer patients in English, Spanish and Arabic.

Note: Much of this information originally appeared in an Aug. 15, 2006 news release from the University of Michigan Health System Department of Public Relations and Marketing Communications.

*Please Note: You will need Adobe Acrobat or Adobe Acrobat Reader to open, view and print this file once you have downloaded it. If you need a free copy of Adobe Acrobat Reader, please click here.

Return to top of page
last updated: 09/06/06


Washington Square Building, 5th Floor · 109 Michigan Ave. · Lansing, Michigan USA 48913 Toll-Free: (877) 588-6224 · Fax: (517) 335-9397 ·

Tell us what you think about this Web site. Take our survey.

Copyright 2000-2008, Michigan Cancer Consortium

Editorial Policy · Disclaimer · Site Index