Prostate Cancer Treatment: A Rebuttal of the Associated Press Article of September 15, 2016

On Thursday, September 15, the Post and Courier published an article from the Associated Press (AP) on a study of prostate cancer treatment options. “10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer” was published in the New England Journal of Medicine (NEJM).

The NEJM article reported on a study of 1,643 men who participated in a clinical trial. The study included three groups of approximately 500 men, each assigned either to monitoring (no treatment), surgery to remove the prostate, or radiation therapy to the prostate. The conclusion was that at 10 years prostate cancer mortality was equal regardless of the treatment, with no significant difference among the three treatment options.

The AP article did note that “More men being monitored and not treated saw their cancers worsen”.

A quote from the lead author was “There’s been no evidence that treating the disease early on makes a difference”.

The final quote in the AP article was from another of the authors, Dr. Malcolm Mason who noted, “We need something to allow us to identify men with aggressive disease earlier”.

What was not mentioned in the AP article but was noted in the NEJM article was that in the non-treated group 3 times as many men developed spread of their prostate cancer to the bones as compared to men treated with surgery and men treated with radiation therapy.

Also not mentioned by the AP was in the men monitored 25% required treatment (surgery or radiation) due to prostate cancer progression within 3 years of beginning monitoring and a total of 54.8% required treatment prior to the 10-year end of study date.

Lowcountry Urology Clinics contacted Dr. Malcolm Mason regarding what we perceived were significant deficiencies in the study.

Our points:

  1. The study was only a 10-year study. This may seem like a long time but with prostate cancer it is not. SEER (Surveillance, Epidemiology and End Results) data from the US indicate that most men with prostate cancer not treated will live 10 years. What is not mentioned in the AP article or the NEJM article is the quality of life in the final 3-4 years of life with prostate cancer that has progressed: spread of the cancer to bones, inability to urinate, bleeding from the prostate and obstruction of the kidneys.
  2. The study showed a 3 times higher incidence of spread of prostate cancer to the bones in the monitored group compared to the two groups who were treated.
  3. In the group of men monitored, over 50% had experienced progression of disease and required treatment prior to the end of the study.

Dr. Mason’s Response: (shortened for space consideration)

  1. “These are 10-year results in a population in which we really need 15 and 20-year followup. This has to be one of the caveats around the results at this stage – including the relatively low mortality rate of prostate cancer”.
  2. “We have certainly gained tremendously in understanding as you say…we need to discuss the data on disease progression and metastasis rates with our patients”.
  3. “I guess that for men with high risk, localized disease the discussion is somewhat different…yes, the threshold for treatment is lower”.

The Bottom Line:

  1. A 10-year study of treatment options for prostate cancer is not sufficient. At least 15 years and preferably 20 years of follow up is needed in order to make valid conclusions.
  2. In all patients with prostate cancer the grade and extent of the cancer as well as the patient’s age and associated medical conditions need to be considered before the patient and the urologist reach a decision regarding the best treatment.
  3. Many men with untreated prostate cancer will live 10 years. However, this does not consider the significantly impaired quality of life during the last 3-4 years of life in those patients with prostate cancer progression.
  4. Every patient and every prostate cancer is different. There is no “one size fits all” option for treating this complex disease.

The Take-away:

Consult your Lowcountry Urology Clinics Urologist prior to making a decision about the treatment of YOUR prostate cancer.