Some aggressive prostate treatment is questioned

January 27, 1994|By Chicago Tribune

Men in their 70s and 80s who are diagnosed with prostate cancer may find that benefits from aggressive treatment aren't worth the side effects, a news study says.

The new study, published in today's New England Journal of Medicine, confirms an earlier report published last year in the Journal of the American Medical Association that suggested widespread enthusiasm for prostate cancer treatment among American physicians may be misplaced.

The University of Chicago report found that older men whose overall life expectancy is 10 years or less when prostate cancer is detected are far more likely to die of some other cause than of untreated prostate cancer.

Because prostate surgery often leaves men incontinent, sexually impotent and otherwise debilitated, patients should be given as clear a picture as possible of their options before they choose to have prostate cancer treated aggressively, said Dr. Gerald Chodak, University of Chicago professor of surgery and lead author of the new study.

The alternative to surgery or radiation therapy is to forgo treatment and to have regular exams so a physician can monitor the cancer's progress, said Dr. Chodak. Hormone treatment may also be prescribed.

"The message here isn't that we should stop treating prostate cancer," Dr. Chodak said. "The message is that patients should be given an idea of the different likely outcomes between aggressive treatment and watchful waiting."

If surgery is used to treat a well-defined cancer, the death rate from prostate cancer after 10 years is likely to be 6 percent, he said. With watchful waiting, the prostate cancer death rate is likely to be 13 percent.

"Now that's twice as high," he noted, "but still not that high overall. When you factor in the side effects from treatment, it's not clear that treatment is that desirable."

The average age for diagnosis of prostate cancer is age 72, and most tumors are localized and considered slow to spread, Dr. Chodak said.

His study pooled patient information from six existing studies that included a total of 828 men.

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