Aggressive Cancer Therapy Backed
.c The Associated Press
By LINDSEY TANNER
CHICAGO (AP) -- A study suggests that men with fast-growing prostate cancer
that has not spread to other parts of the body fare much better if treated
with surgery or traditional radiation rather than implanted radioactive
``seeds,'' an increasingly popular approach.
A second study appears to suggest that in cases of fast-growing prostate
cancer, doctors may want to rethink the practice of ``watchful waiting,'' in
which older men are left untreated on the assumption that other ailments are
more likely to kill them first.
Both studies, published in Wednesday's Journal of the American Medical
Association, buttress previous research.
If confirmed by further research, the studies could help doctors and patients
choose the most appropriate treatment for what is the second-leading cancer
killer of men, behind lung cancer.
An estimated 184,500 men nationwide will be diagnosed this year with cancer of
the prostate, a walnut-sized gland that is involved in semen production.
Nearly one fifth of them will die, according to the American Cancer Society.
The first study may dampen the popularity of brachytherapy, in which tiny
``seeds'' of radioactive material are injected into the prostate.
Brachytherapy has become more prevalent in the past decade because it causes
fewer of the side effects associated with prostate cancer treatment such as
impotence and incontinence. The seeds also tend to require only an overnight
stay at a hospital and no follow-up treatments.
Researchers from Harvard Medical School and the University of Pennsylvania
looked at the treatment of 1,872 men with slow-, medium- or fast-growing
tumors. The men received either a radical prostatectomy, which involves the
removal of the prostate plus surrounding tissue; traditional radiation; or
The study found that brachytherapy patients with the most aggressive tumors
were as much as twice as likely to have their cancer recur within four or five
years as men who had surgery or traditional radiation.
Brachytherapy patients with medium-growing tumors were more than three times
as likely to have their cancer recur within five years as men who had surgery
or traditional radiation. However, the brachytherapy patients fared as well as
the others if hormone therapy was used, according to the study, led by Harvard
radiation oncologist Dr. Anthony D'Amico.
Those with slow-growing cancer -- which constitutes only about 20 percent of
all diagnoses nationwide -- fared equally well regardless of which treatment
In the second study, University of Connecticut Health Center researchers
studied 767 patients who received minimal treatment. Those with the most
aggressive tumors faced a 60 percent to 87 percent chance of dying from the
disease within 15 years of diagnosis, even up to age 74.
The risk of death for those with medium tumors was anywhere from 6 percent to
70 percent, and for those with slow-growing tumors it was 4 percent to 7
``This study strongly showed that the only men you could write off are the men
after age 74,'' said Dr. William Catalona, chief of urology at Washington
University School of Medicine in St. Louis. ``It appears that early diagnosis
and treatment would be warranted'' in men 74 and younger.
In an accompanying editorial, Dr. Gerald Chodak of Chicago's Louis A. Weiss
Memorial Hospital said the studies fail to determine which is treatment is the
best, leaving ``physicians and their patients without definitive answers to
these pressing questions.''
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