Treatment Options For Prostate Cancer Investigated - Is Invasive Treatment Better than Watching and Waiting Approach - Symptoms

March 26th 2006

Prostate

A new study is underway to determine if low-risk prostate cancer patients do better or as well using the watchful waiting approach compared to those that have invasive surgery. In this study 200 of the 650 patients needed have already enrolled. These men have been diagnosed with low-risk prostate cancer at M. D. Anderson and are on active surveillance for their disease, having changes monitored through regular Prostate Specific Antigen (PSA) tests, biopsies and check-ups.

Now that men are routinely tested for PSA blood test beginning in their 40’s, thousands of men have had their prostate cancer detected at such an early stage that managing low-risk disease through surveillance may outweigh the risks and possible side effects of treatments. This is what doctors at The University of Texas M. D. Anderson Cancer Center hope to determine with their new study.

Jeri Kim, M.D said "With the advent of the PSA test, we see prostate cancer detected much earlier but there is no evidence that early detection means longer survival. Because of the sensitivity of the test, clinically insignificant tumors sometimes are over-diagnosed and patients may, as a consequence, be over-treated with radiation and surgery.” Kim is the principal investigator of the study and assistant professor in the Department of Genitourinary Medical Oncology at M. D. Anderson.

The study will enroll 650 prostate cancer patients who have been clinically defined either as low risk, or patients with localized prostate cancer who have refused early intervention, or patients with localized cancer who are precluded from therapy due to other serious health conditions. Patients who have had previous treatment for their prostate cancer are not eligible to participate.

The patients will have a biopsy at the beginning of the study to confirm the diagnosis of localized prostate cancer followed by PSA tests and digital rectal exams every six months. The need for additional biopsies will be determined at the end of the first year of surveillance, and participants on the study will be given a transrectal ultrasonography annually to detect any possible changes.

Patients also will be asked to complete a survey on their general health conditions as well as six other short surveys which will be used to monitor diet and behavior as part of related research.

According to the researchers, prostate cancer is one of only a few cancers that can be latent in the body for some time, not requiring immediate treatment. Kim said “Many researchers have documented over the years that men die with their disease rather than from it, and while we need to intervene early, we also need to intervene appropriately with respect to the stage of disease, the man's age, his health in general and quality of life."

Most of the times there are no symptoms for prostate cancer early on. This is why it is important to get a PSA test early. The earlier tests will also help determine a baseline PSA which naturally goes up with age. The rate of increase along with levels of PSA can help doctors determine how fast the cancer is growing.

Some of the symptoms are: Frequent urination, especially at night, inability to urinate, trouble starting or holding back urination, a weak or interrupted flow of urine, painful or burning urination, blood in the urine or semen, painful ejaculation, frequent pain in the lower back, hips and / or upper thighs. These can be symptoms of cancer, but more often they are symptoms of noncancerous conditions. It is important to check with a doctor.