Majority of low-risk prostate cancer is treated aggressively
MedWire News: The majority of men with low-risk prostate cancer are nonetheless treated aggressively, say US researchers who analyzed risk profiles and factors associated with treatment using the Surveillance, Epidemiology, and End Results (SEER) database.
The team found that over 75% of men in the study with prostate-specific antigen (PSA) levels below 4 ng/ml and low-risk disease were treated with radical prostatectomy (RP) or radiotherapy (RT).
Furthermore, "despite their lower risk for having clinically significant disease, treatment rates for men with PSA values of 4 ng/ml or lower were comparable to those of men presenting with PSA values between 4 and 20 ng/ml," write Grace Lu-Yao from the University of Medicine and Dentistry of New Jersey in Piscataway, USA, and colleagues.
The team writes in response to some experts' beliefs that the PSA threshold for prostate biopsy should be lowered from its current recommendation of 4.0 ng/ml to 2.5 ng/ml, despite an acknowledged concern about the potential risk for overdiagnosis and overtreatment of localized disease.
Using 2004-2006 data for 1,23,934 men from the SEER registry, Lu-Yao and co-authors describe the risk profiles and treatment patterns of men with a PSA below 4 ng/ml at diagnosis.
Overall, 14% of the cohort had a PSA level below 4 ng/ml, and of these patients, 54% had low-risk disease, defined as stage T2 or below, a PSA level of 10 ng/ml or less, and a Gleason score of 6 or less.
RP was performed on 44% of men with a PSA of 4 ng/ml or lower, while 33% underwent RT.
Finally, 38% of men with a PSA of 4 ng/ml or below had screen-detected prostate cancer, and were 49% and 39% more likely to undergo RP and RT, but 33% less likely to have high-grade disease than men who had non-screen detected prostate cancer.
"These results underscore the fact that PSA level... is not a sufficient basis for treatment decisions," Lu-Yao et al conclude in the Archives of Internal Medicine.
They estimate that if the prostate biopsy threshold were lowered to a PSA of 2.5 ng/ml, the number of men with abnormal PSA levels in the study cohort would double to approximately 6 million.
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By Sarah Guy