Dear Dr. Mirkin:
Should all prostate cancers be treated?
Answer: Twenty to forty percent of prostate cancers are of such low risk of spreading through the body that they should probably be treated with "active surveillance." In one study, 65-year-old men with low-risk prostate cancer who were given this watchful waiting had 11 years of "quality of life"; many months more than those treated with internal radiation therapy (brachytherapy, radioactive seeds), intensity-modulated radiation therapy (beam radiation), or surgical radical prostatectomy (Journal of the American Medical Association. December 1, 2010).
Prostate cancers that are small, localized to one area, and do not look very malignant under the microscope are called low risk. In the study, these men were treated with "active surveillance": frequent PSA tests, physical exams, and periodic biopsies to monitor the cancer’s growth.
From previous studies, the authors knew that those who chose immediate treatment reduced their risk of dying from prostate cancer by 17 percent. However, treatment for prostate cancer can cause impotence, incontinence and infections, so the authors devised a "quality of life" scale comparing lengthening of life with adverse side effects. The low risk group who chose watchful waiting had the most quality years.
This recommendation applies only to men with prostate cancer who can live with the fear of not being treated. Watchful waiting is only for men who put a premium on quality of life over the unproved theory that lack of treatment shortens lives. The authors emphasize that, "for some men and their families, the concept that a cancer of any sort is not treated when found early is unthinkable."
A practicing physician for more than 40 years and a radio talk show host for 25, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is one of a very few doctors board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology.
Dr. Mirkin's latest book is The Healthy Heart Miracle, published by HarperCollins. His daily short features on fitness have been heard on CBS Radio News stations since the 1970's.
He has written 16 books including The Sportsmedicine Book, the best-selling book on the subject that has been translated into many languages. Dr. Mirkin did his residency at the Massachusetts General Hospital and over the years he has served as a Teaching Fellow at Johns Hopkins Medical School, Assistant Professor at the University of Maryland, and Associate Clinical Professor in Pediatrics at the Georgetown University School of Medicine.
Read more at www.drmirkin.com.
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