Prostate cancer treatment: Still more questions than answers

How to appropriately treat early-stage prostate cancer still remains a hotbed of controversy, with various studies often suggesting conflicting recommendations. In order to shed more light on this topic, Dr. Raveendhara Bannuru at Tufts Medical Center carried out a meta-analysis of 75 studies to determine the risks and benefits of various forms of radiation therapy for prostate cancer. Unfortunately — as in most such meta-analyses (reviews of multiple studies) — comparing different trials is difficult because of the differences between treatments, patients, and primary outcomes. Yet despite these confounding variables, the authors found that an extra 1,500 rads of localized radiation to the prostate is effective at reducing PSA (prostate-specific antigen, a general measure of prostate cancer’s extent) without any additional urinary or bowel side effects.

But ACSH's Dr. Gilbert Ross finds it somewhat hard to believe that these patients would not experience an increase in side effects from the added radiation dose. “The studies only tracked men for a few years,” he observes, “so problems related to the extra radiation may not arise until further down the road.” Further, the question of actual outcomes — will an improved PSA level translate into less severe disease? — remains unanswered by these studies.

ACSH’s Dr. Elizabeth Whelan finds that the results of this study only further muddy the waters. “It’s difficult to separate the meat from the bone when trying to evaluate all of the data available on prostate cancer treatment,” she says. “It’s hard for a patient to figure out which decision is the right one to make, and even many primary care doctors are unsure of the best treatment.”

Dr. Peter Albertsen of the University of Connecticut Health Center in Farmington noted to Reuters Health that men who are faced with various treatment choices should speak to their doctors, radiation therapists, and surgeons to decide “what’s right for you.”