It’s Not As Easy Of A Decision As You May Think
There’s not a week that goes by in my clinical practice when I don’t talk with prostate cancer patients about their options – surgery, radiation, or “watchful waiting.” Most patients are surprised that there are no “national standards” for watchful waiting. But most prostate cancer specialists offer watchful waiting to men with a Gleason score of 6 and a PSA of less than 10 mg/mL, along with a prostate cancer that appears to be contained within the prostate capsule.
But a recent study, published in the August 2015 issue of the Journal of Urology, may change all that. Dr. Paul Nguyen and co-workers from Harvard studied 10,273 man diagnosed with so-called “low risk” prostate cancer in 2010 and 2011.
The surprising finding was that nearly half of the men (4,467 patients) had worse disease found at time of surgery. In fact, most of the patients were found to have more aggressive, Gleason 7 prostate cancers. And 10% of men (992 patients) had their tumor stage increased at the time of surgery, with almost all of these patients having prostate cancer extension through the capsule itself.
What Does This All Mean for the Patient With Early Stage Prostate Cancer?
Dr. Paul Nguyen at Harvard did all of us a real favor by “drilling down” to the nuts and bolts of the possible winners and losers who are thinking about the “watchful waiting” approach. Their study found 3 key factors associated with upgrading and upstaging of so-called “low risk prostate cancers.”
The 3 key factors are:
1. Age greater than 60 years
2. PSA greater than 5 ng/mL
3. Greater than 25% positive biopsies
To put new facts into perspective, a 65 year-old man with a PSA of 8 ng/ML and 2 of 6 positive core biopsies has a 60% chance of having higher grade, more aggressive prostate cancer.
The new study makes the decision for “watchful waiting” in early stage prostate cancer patients a bit less clear. Other ways to look at the prostate, such as MRI scans, may be helpful but are in the early stages of development.
If you want more information about your prostate cancer, call me Dr. Edward Hughes at 855-DAYTON1.