Dr. Yan Yan and colleagues from the Washington University School of Medicine in St. Louis, Missouri, studied 1,809 men whose prostate cancer was diagnosed through a screening program at the university, and who had chosen one of these three options. The men, average age 67, completed questionnaires after they had made their treatment decisions, and again a year later. In addition, the researchers looked at the men`s medical records.
"Race, clinical stage, pretreatment urinary and sexual function, PSA level, and age at diagnosis were important factors accounting for differences in the selected treatment," the researchers report.
About 79% of the men chose radical prostatectomy -- surgical removal of the prostate. Twelve percent chose radiation therapy, and 8% watchful waiting.
With each additional 5 years of age, a man was twice as likely to choose watchful waiting over radiation, and twice as likely to choose radiation over surgery.
"Patients are concerned with their sexual function when they select treatments," noted the researchers. They found that men who had normal sexual function before their diagnosis were twice as likely to choose watchful waiting.
Not surprisingly, men with larger tumors and those with higher PSA levels -- factors indicating greater risk for cancer progression -- were much more likely to choose surgery or radiation over waiting.
Writing in the March issue of the journal Cancer, Yan and colleagues report that African-American men were more than twice as likely to choose radiation over waiting, which makes sense because this group tends to get prostate cancer earlier and advance faster. But men of other races were four times more likely to choose surgery, and more than twice as likely to choose radiation than African-Americans, a finding the researchers suggest could be due to the fact that African-Americans tend to be younger at diagnosis.
For 60% of these men, their cancer was detected through elevated blood levels of prostate-specific antigen. For 10% of the men, it was detected through digital rectal exams. The remaining men had both indications.
The American Cancer Society recommends that men 50 and older have yearly screenings for prostate cancer. When found early, this cancer is highly curable with one of the treatments discussed in this study.
SOURCE: Cancer 2000;88:1122-1130.