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Watchful waiting for prostate cancer has downside

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According to the Los Angeles County Department of Public Health, prostate cancer is the second most common cause of cancer deaths in the county. However, some men who are diagnosed with slow growing tumors are recommended to undergo active surveillance rather than undergoing surgery and/or radiation therapy. These men receive periodic tests to determine whether the disease has progressed. However, a new study has found that this strategy allows some of the cancers to progress to a dangerous level. The findings were published online on April 10 by researchers at the University of Cambridge in the United Kingdom.

The study authors note that the identification of men harboring insignificant prostate cancer is important for the selection of patients for active surveillance. As a results, procedures have been developed to identify men who should undergo the strategy based on clinical and biopsy findings. Therefore, the investigators conducted a study to evaluate the appropriateness of active surveillance.

The study group comprised 848 men who underwent a radical prostatectomy from July 2007 through October 2011 at an English tertiary care facility. Tumor volume was measured via a pathologic examination. For each diagnostic method, statistical analysis was conducted to determine whether the disease qualified to be insignificant by three different criteria. The comparison of the accuracy of the procedures in the screened (by PSA test) and unscreened populations was made.

The researchers found that, among the 848 men, 415 had Gleason 3+3 disease on biopsy. Of patients, 32.0% had extension of the disease beyond the prostate and 50.2% were upgraded. One man had positive lymph nodes; 206 men (24%) were D’Amico low risk. Of these, 143 had more than two positive biopsy samples. None of the diagnostic techniques had adequate discriminative power in predicting whether the tumor was insignificant. They found that the accuracy of the tests was low in both PSA-screened and -unscreened populations.

The authors concluded that among the unscreened population, diagnostic techniques designed to identify insignificant prostate cancer are inaccurate. They suggested that a wider size range of prostate tumors in the unscreened might have contributed to the inaccuracy.

Take home message:

If you are diagnosed with prostate cancer, it would be prudent to get a second opinion at a tertiary facility such as Ronald Reagan UCLA Medical Center (unless that is where the disease was diagnosed). Not all men diagnosed with prostate cancer require surgery and/or radiation treatment at the time of diagnosis. Thoroughly discuss the pros and cons of active surveillance with a specialist in prostate disease.

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