Prompt treatment or "watchful waiting" for prostate cancer?
Conflicting results from two new studies into the best way to deal with early-stage prostate cancer have been announced this week.
An increasing number of prostate cancer cases have been diagnosed at an early stage since the advent of improved testing in the mid-1980s.
But among older men, particularly those with other health difficulties, doctors do not always automatically prescribe treatment such as radiotherapy or surgery due to the complications and distress it may cause.
Instead, patients are carefully monitored so-called "watchful waiting" and only treated when it is necessary.
At the 2006 Prostate Cancer Symposium in San Francisco, Dr Yu-Ning Wong of the Fox Chase Cancer Centre presented the results of a study of nearly 50,000 prostate cancer patients aged between 65 and 80.
Around 35,000 of the men were treated for early-stage prostate cancer, while the rest were monitored. The researchers found that treating the cancer boosted average survival to 13 years, compared with 10 years for the "watchful waiters".
However, new results from Dr H. Ballentine Carter at the Johns Hopkins School of Medicine in the U.S. contradict Dr Wong's findings.
In the March 1 issue of the Journal of the National Cancer Institute, Dr Carter reports that there is no difference in survival between prostate cancer patients who are treated and those who are monitored. But this study only looked at around 500 men, making it less statistically reliable than the Fox Chase investigation.
"Some prostate cancers grow so slowly that they never become life-threatening, especially in elderly men who may die of other causes before the cancer causes problems," explained Dr Wong.
"But other men develop complications and die from their cancer making the decision to treat quite difficult.
Dr Wong's results suggest that men with early-stage prostate cancer should be considered for treatment, rather than monitoring.
In the UK, the NHS is funding a study involving more than 200,000 men, to discover whether active treatment or watchful waiting? is best for prostate cancer patients.