A new study is suggesting that overdetection of recurrence after primary treatment for prostate cancer is a problem for patients with prostate cancer. Seattle researchers are reporting that simply too many men are being treated for recurrence and receiving salvage radiation, hormonal therapy, and other secondary therapies unnecessarily following radical prostatectomy (RP).
The study, which was published in Clinical Cancer Research, suggests that prostate specific antigen (PSA) screening in some cases led to overdetection of prostate cancer, and now the same is occurring with recurrence.1
“Until now, no one has quantified how often this might be happening. But that it was happening among a noticeable fraction of patients was pretty clear from the old studies from Johns Hopkins that showed a long time from PSA rise to metastasis in the absence of treatment,” said study author Ruth Etzioni, PhD, of the University of Washington in Seattle, WA.
Dr. Etzioni said previous studies have indicated that the interval from PSA recurrence to metastasis is quite long, with a median of more than 8 years. She and her colleagues used data from different sources and created a simulation model that found that at least 9.1% of patients with prostate cancer had overdetection of recurrence following RP at 5 years and that number shot up to 15.6% after 10 years.
Among men older than age 70 with a PSA recurrence within 10 years of first diagnosis, the problem of overdetection was estimated to be 31.4%.
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“I think that our result should caution doctors and patients about moving too quickly to treat on the basis of PSA rise, particularly among older men,” Dr. Etzioni told Cancer Therapy Advisor. “This study reveals the harm of early treatment of recurrence. We need to understand the benefit so we can look at harm–benefit tradeoffs.”
Dr. Etzioni explained that salvage radiation therapy can result in bowel problems and urinary symptoms. In addition, hormone therapy is known to cause hot flashes, fatigue, and loss of libido and long-term androgen suppression therapy also has been linked with osteoporosis, heart disease, and diabetes. Dr. Etzioni said there is a need to determine which men need salvage therapy and when to administer it.