Medical Edge Newspaper Column

Slow-Growing Prostate Cancer May Not Require Treatment

Feb. 20, 2006
DEAR MAYO CLINIC:
I am a 75-year-old man in excellent health and still sexually active. After a minimally elevated prostate-specific antigen test, one of six needle biopsies showed prostate cancer. My doctor says to do nothing because my quality of life would be better. This doesn't seem right. What should I do? -- Seattle

ANSWER:
Watchful waiting is commonly recommended for men 75 and older with slow-growing prostate cancer. For many men, prostate cancer grows very slowly, stays within the prostate gland and won't cause serious problems during the patient's expected lifetime.

Treatment is advised only when signs and symptoms indicate that the cancer is growing. That's because prostate cancer treatment can cause life-changing side effects such as incontinence, erectile dysfunction, rectal damage and loss of sex drive.

The biopsy confirms the presence of prostate cancer and provides information to determine its aggressiveness. The Gleason Scale, named after the doctor who developed it, is commonly used to "grade" prostate cancer. Pathologists compare the pattern of abnormal cells to normal prostate tissue to determine a score. The lower the score, the better. Scores from 2 to 6 indicate a slow-growing cancer where watchful waiting may be advised. Scores from 7 to 10 indicate a more aggressive tumor.

If and when you decide to proceed with treatment, you have several options to consider:

Radiation therapy can be administered in two ways. External radiation -- high-powered X-rays -- is aimed at the prostate to kill cancer cells. Or doctors can implant rice-sized radioactive seeds into the prostate gland. Radiation therapies can cause erectile dysfunction and injure the rectum and bladder.

Hormone therapy to reduce testosterone levels in the blood is effective in stopping prostate cancer growth. Hormone therapy consists of regular injections and/or tablets, or removal of the testicles. Hormone therapy stops your libido; you could completely lose interest in sex.

Surgically removing the prostate, called radical prostatectomy, is generally recommended for younger men. For men 75 and older, about 25 percent have urinary incontinence as a result of the surgery. Impotence is also a likely side effect.

Watchful waiting isn't the same as doing nothing. See your doctor for regular prostate-specific antigen (PSA) rechecks every six to 12 months. If your PSA count jumps or you have new symptoms, you'll want to review your treatment options with your doctor. Symptoms to watch for include:

• Difficulty emptying the bladder.

• Blood in the urine.

• Severe bone pain, particularly in the spine and pelvis.

• Loss of appetite and weight.

-- Michael Lieber, M.D., Urology, Mayo Clinic, Rochester, Minn.