Results from the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4), showing that men with early-stage prostate cancer, particularly men under 65 years old, treated with radical prostatectomy had increased survival compared to those assigned to watchful waiting, has raised concerns among physicians and their patients. H. Ballentine Carter, MD, Professor of Urology, Oncology, and Director, Division of Adult Urology, Brady Urological Institute, at Johns Hopkins Medicine in Baltimore, told The ASCO Post that he had has many discussions about the study with colleagues, “but also patients, who will bring in the article and say. ‘How should I interpret this?’” Patients who have been diagnosed with early-stage prostate cancer want to know if the study means they should have immediate surgery rather than continue on active surveillance.

Take-Home Message

Dr. Carter said that the guidance he offers physicians who are asked about the study by patients is basically what he has said for a long time: “For any man over age 65 who gets diagnosed with low-risk disease, he should not be asking, ‘What treatment should I have?’ He should be asking, ‘Do I need to be treated at all?’ That, to me, is the take-home message.”

For men under age 65 who have very low– to low-risk disease, the decision may be more difficult, taking into account potential benefits and longer life expectancy. As with all patients, that decision “has to be based on personal preferences,” he stressed.

For men with intermediate-risk disease and less than a 10-year life expectancy, “surveillance could be an option for those people, maybe even preferred,” Dr. Carter added. “But for all other people who have more than a 10-year life expectancy with intermediate- and certainly high-risk disease, they should be treated aggressively, because we know that treatment will prolong life.” ■