The proportion of US men with early, slow-growing prostate
cancer who received robotic surgery and other expensive treatments increased
between 2004 and 2009, according to a new study.
Researchers found that use of those therapies also rose
among men who were unlikely to die from prostate cancer because they were sick
with other chronic diseases when their cancer was diagnosed.
"You can't get at what the right rate (of treatment
use) is from our study, but what we did find was treatment with these advanced
technologies increased over the past decade, and was fairly common," said
Dr Brent Hollenbeck, who worked on the study at the University of Michigan in
Evidence has been building that a wait-and-see approach
might be most effective for men with low-risk prostate cancer that may or may
not progress, rather than scheduling surgery or radiation right away. But both
doctors and patients have been hesitant to adopt that strategy, also known as
watchful waiting or active surveillance, researchers said.
"There's no incentive for (doctors) to do it, because
there's no real payment, and it's very complicated. It's not easy to do active
surveillance," said Grace Lu-Yao, who studies prostate cancer treatment at
Robert Wood Johnson Medical School in New Brunswick, New Jersey.
What's more, she told Reuters Health, "Some patients
may just feel they'll go with the most advanced technology and get rid of the
cancer, so they'll feel more secure in a way." Hollenbeck and his
colleagues analysed data on about 56 000 older men diagnosed with prostate
cancer and covered by Medicare, the government's health insurance program for
the elderly and disabled.
They found that among
men with low-risk cancers, use of high-end treatment -- including robotic
surgery and high-precision radiation, known as intensity-modulated radiation
therapy -- increased from 32% in 2004 to 44% in 2009. Likewise, the
technologies' use among men with other serious health problems increased from
36% to 57%, Hollenbeck and his colleagues reported on Tuesday in the Journal of
the American Medical Association.
Those high-end treatments largely replaced the use of older
therapies, which became less common, the researchers found. Close to half of
men diagnosed with low-risk cancer across the study period took a wait-and-see
approach. According to Healthcare Blue Book, prostate removal costs about
$13,000 (about R130 000) -- and robotic surgery usually adds to the price tag.
Treatment also comes with a risk of side effects including
impotence and incontinence. "In someone who stands to benefit less, when
there's no clear advantage to treatment in terms of preventing death from
prostate cancer, the cumulative side effects of the procedure may outweigh the
aggregate benefit," Hollenbeck told Reuters Health.
However, one of the challenges of taking a more conservative
approach, according to Lu-Yao, is that there are no standards for how often to
check men to make sure their cancer hasn't grown, or on when to intervene. And
it's not always clear which patients are the best candidates for watchful
waiting or active surveillance, she said.
"We understand we are doing a lot of overtreatment, but
we don't really know which patients are being overtreated," said Lu-Yao,
who wasn't involved in the new research. It can also be hard to tell which men
have a limited life expectancy because of other diseases, and which ones can
expect to live long enough to possibly benefit from treatment, Hollenbeck
added. "Patients that are older and have low-risk disease or have a lot of
other health problems should really have a frank discussion with their
physician about the perceived benefits of treating their cancer," he said.