Study Backs Conservative Approach to Some Prostate Cancer
ROBERT SIEGEL, host:
Men with low-grade prostate cancer can safely choose conservative treatment, just frequent medical checkups or hormone therapy. That's the conclusion of research in this week's Journal of the American Medical Association. The study shows men with less-aggressive cancer are unlikely to die from their disease even 20 years after diagnosis. But not all researchers agree. As NPR's Patricia Neighmond reports, some still argue that what doctors call `watchful waiting' may be dangerous.
PATRICIA NEIGHMOND reporting:
Dr. Peter Albertsen is a urologist at the University of Connecticut Health Center. He reviewed medical records of 767 men diagnosed with prostate cancer between 1971 and 1984. When he first published the results of his study, he found that after 15 years, men with low-grade disease were unlikely to see the cancer spread or die from the disease even when it was treated conservatively. This study published today looked at those same patients even longer, following them for a total of 20 years. Albertsen.
Dr. PETER ALBERTSEN (University of Connecticut Health Center): Low-grade disease does not carry the lethal connotations that high-grade disease does. And hence, people may want to think twice about aggressive treatment, especially if they have a very low-grade tumor.
NEIGHMOND: And `low-grade' is the key word here. Whether a tumor's low-grade or not is figured out using something called the Gleason score, named appropriately for pathologist Donald Gleason, who developed it over 30 years ago.
Dr. ALBERTSEN: He developed a scoring system based on the low-power look of the glands as he looked at them under the microscope and worked out a system where he could identify those cancers that appeared to progress slowly vs. the ones that progressed rapidly.
NEIGHMOND: Gleason determined that low-grade tumor cells looked similar to normal prostate cells, only thicker. Cells from high-grade tumors, on the other hand, looked more bulbous and wild. In this study, men with high-grade tumors had a high probability of dying from the disease within 10 years of diagnosis.
Editorial writer Peter Gann is an epidemiologist at Northwestern University. Gann is among researchers who say the question isn't resolved completely. He cites a Swedish study published last year which came to the opposite conclusion of the study published today.
Mr. PETER GANN (Northwestern University): After 15 years, if you look at the death rate from prostate cancer, it actually started to go up.
NEIGHMOND: Gann says that could mean something biological happens 10 or 15 years after diagnosis.
Mr. GANN: That could suggest that there is something that occurs very late after diagnosis that can reactivate or restimulate these tumors. In other words, there could be residual, latent cancer that's lurking and something is capable of reactivating this.
NEIGHMOND: But even if tumors can suddenly change after 10 years, Dr. Peter Albertsen says it doesn't happen very often. Otherwise, the death rates in his study would be higher. Meanwhile, research is under way to answer this key question: Whether, in some cases, cancer becomes more aggressive, and why. Scientists are trying to devise tests to predict such changes. They're studying tumors using radiological imaging, looking at molecular markers on the tumors and analyzing protein patterns in the blood. Patricia Neighmond, NPR News.
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