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full screen PSA tests via blood samples are a way to follow the development of prostate cancer. Archive image. Photo: Dan Hansson/Svd/TT
Older men who have other diseases and are diagnosed with prostate cancer are often better off not receiving treatment – the so-called “wait and see” strategy.
– It may seem backwards, but is often the right thing, says Pär Stattin, one of the researchers behind the study.
It concerns men who are diagnosed with localized prostate cancer at an advanced age. They can advantageously wait with treatment.
– Of course, a patient should have treatment when needed, but we want to avoid treating unnecessarily. It’s a balancing act in prostate cancer care, says Pär Stattin, professor of urology at Uppsala University.
Together with colleagues, he has collected data on 5,234 men in the National Prostate Cancer Registry with an expected survival of less than ten years. Survival was based on age and other illnesses the men had.
Died of something else
Of the men who died within ten years of diagnosis, 92 percent of the men with low-risk cancer and 84 percent of those with high-risk cancer had died from causes other than prostate cancer.
The results, published in Jama Network Open, show that most of these men had not needed hormone therapy. Hormone therapy is given when the prostate cancer grows and causes symptoms and aims to reduce the levels of male sex hormone. The side effects are, for example, an increased risk of broken bones, reduced muscle mass, poorer blood sugar regulation and loss of sexual ability.
– When the cancer grows, you absolutely have to treat it, but we see in the study that most people died of other causes before they got symptoms of the cancer. In these cases, it is much better to observe and not treat.
Swedish strategy
In Sweden, this strategy is used, which the study supports, according to Pär Stattin.
– But it is important that patients with prostate cancer who “wait and see” have regular contact with healthcare so that treatment is given when needed.
For men with longer expected survival and localized prostate cancer, the strategy of active monitoring is used. Then you have more frequent follow-ups with, among other things, PSA checks and an examination with a magnetic resonance camera. The treatments if the cancer shows signs of growing are surgery or radiation.
– For most men today, prostate cancer is a chronic disease that can be cured or slowed down and not a fatal disease, he says.