Monitoring can be the right choice for local prostate cancer, study suggests

How local prostate cancer, that is, cancer that has not spread outside the prostate gland, should be treated is a controversial issue. In many cases such tumors grow only very slowly, and one treatment strategy is to monitor them rather than to actively intervene directly.

Pär Stattin and his associates evaluated the outcomes for 6,849 men aged up to 70 years in the Swedish National Prostate Cancer Registry (NPCR) who had a local tumor with low or moderately high risk of spreading. During the years 1997-2002 monitoring of 2,021 of these men commenced, while 3,399 had their prostate gland surgically removed and 1,429 received radiation treatment.

With a median follow-up time of over 8 years, the researchers find that the risk of dying of prostate cancer within ten years was a total of 3.6 % in the group that was monitored (2.4 % with low-risk tumors and 5.2 % with tumors of moderately high risk) and somewhat lower among men who underwent active treatment: 2.5 % among those who were operated on and 3.3 % among those receiving radiation. The risk of dying from causes other than cancer was nearly twice as high among men who were monitored, which indicates that men with other conditions and shorter estimated remaining lifetimes were monitored more often than more healthy men.

The authors of the study conclude that monitoring of tumor development is the best alternative for many men with local prostate cancer of the low-risk type. Besides Pär Stattin, co-authors are Erik Holmberg and Jonas Hugosson, both with the Sahlgrenska Academy, Gothenburg University; Jan-Erik Johansson, University Hospital in Örebro; Lars Holmberg, King's College, London, UK; and Jan Adolfsson, Karolinska institute.