Treating indolent prostate tumors: How far to go?

FDA hearings begin today on the possibility of expanding the list of approved uses for Avodart and Proscar, two drugs widely prescribed to shrink enlarged prostates. This treatment relieves annoying urinary symptoms in men with BPH — benign prostatic hypertrophy. Also today a new study was published in the Journal of the American Medical Association (JAMA) suggesting that less aggressive forms of treatment may be preferable for many patients with small and slow-growing (indolent) cancers.

Based on computer modeling of data from many older studies, the researchers argue that the quality-adjusted life expectancy of patients treated with what it calls “active surveillance,” which it defines as “a strategy of close monitoring of newly diagnosed patients,” was better than for subjects who underwent seed radiation or beam radiation therapy, or prostatectomy. ACSH President Dr. Elizabeth Whelan comments that this finding is “very important. So many men diagnosed with prostate cancer will just say, ‘Let’s get it out, even if the tumor is likely to be non-aggressive.' But this seems often not to be the best approach.”

ACSH’s Dr. Gilbert Ross concurs, observing that “although prostate cancer is among the most common causes of cancer death in men in the country, that does not mean that all prostate cancers are best treated with complete removal. What is also so necessary is educating patients with indolent prostate cancer that they don’t necessarily have to undergo radiation or a prostatectomy.” Dr. Ross points out that these treatments are “associated with an increased risk of incontinence and impotence.”

With respect to the use of Proscar or Avodart as a prophylactic drug intended to diminish the risk of developing prostate cancer, Dr. Ross cautions that because these reduce PSA readings, such chemoprevention may also reduce a doctor’s ability to detect disease onset, and “the benefit of the drug might be more apparent than real.”