Swedish study suggests not treating some prostate cancers
Johns Hopkins doctor disagrees
February 11, 1997
Web posted at: 10:30 p.m. EST
From Correspondent Dan Rutz
ATLANTA (CNN) -- Behind lung cancer, prostate cancer is the leading cancer killer for men. Although it is usually treatable if diagnosed early, a new study by a group of Swedish scientists questions whether immediate treatment is always the best move.
Prostate cancers aren't all curable, and they don't even grow at the same rate. Some, in fact, grow so slowly that they never pose a threat to life, especially for older men. Meanwhile, treatment of any prostate cancer has some serious drawbacks. Prostate cancer surgery often makes men impotent, and sometimes incontinent, too.
Thus, if a prostate cancer is growing so slowly that it will never threaten the life of its victim, the logical action would be no action. The trick is to determine who needs aggressive treatment, and who does not. Swedish doctors usually employ "watchful waiting" -- in other words, no treatment -- to determine which patients need radical treatment.
The study, published in this week's Journal of the American Medical Association, concluded that after 15 years, men with early-stage prostate cancer were just about as likely to survive with or without treatment. It followed 642 patients diagnosed with prostate cancer for its study.
Dr. Patrick Walsh, who is chief of urology at Johns Hopkins Medical School, disagrees with the study's findings. "I think it's misleading. The authors conclude that there's no reason to treat localized cancer because it doesn't kill anyone," he said.
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"My question is, if localized prostate cancer doesn't kill anyone, why does Sweden have one of the highest death rates from prostate cancer in the world?" According to Walsh, Swedish men are 27 percent more likely to die of prostate cancer than their American counterparts.
Walsh is a firm believer in removing cancerous prostates from men who are expected to live at least 10 years, providing the cancer hasn't spread -- a strategy the Swedish study called "substantial overtreatment."
In the Swedish study, the average age of subjects at diagnosis was 72. In the United States, many men in that age range wouldn't get aggressive treatment either. But from the American Urological Association on down, the consensus is that failing to treat younger men with prostate cancer consigns them to an early death.
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