Many older men diagnosed with early-stage prostate cancer will not require treatment or will die of causes other than prostate cancer, according to a new study. This study is the first to examine the development of untreated prostate cancer in a time when prostate-specific antigen (PSA) testing is common, which is important because PSA tests can detect cancer six to 13 months earlier than traditional diagnostic methods.

In this study, researchers analyzed data on 9,018 men from the U.S. Surveillance, Epidemiology and End Results (SEER) database who had been diagnosed with stage I or stage II prostate cancer between 1992 and 2002. The median age of the men was 77, and they had not received surgery, radiation therapy, or hormone therapy within six months of diagnosis.

The results showed that most men died from causes not related to prostate cancer or did not have prostate cancer that advanced to the point where treatment was needed. Of the 2,675 men who did receive treatment, the time between diagnosis and the start of cancer therapy was about 11 years. Men with less aggressive (slower growing) cancer were less likely to need treatment than those with aggressive (faster growing) cancer. After 10 years, 3% to 7% of men with less aggressive or moderately-aggressive cancer had died of prostate cancer, compared with 23% of men with aggressive cancer.

“Because prostate cancer therapies are associated with significant side effects, our data can help patients make better informed decisions about the most appropriate approach for them and potentially avoid treatment without adversely affecting their health,” said lead author Grace Lu-Yao, PhD, Cancer Epidemiologist at The Cancer Institute of New Jersey and Associate Professor at UMDNJ-Robert Wood Johnson Medical School and School of Public Health. Dr. Lu-Yao added that men who choose not to undergo treatment should be carefully monitored for rising PSA levels and other signs of cancer growth, an approach called active surveillance.

What this means for patients

This study suggests that older men with early-stage prostate cancer may not need treatment right away. These men should talk with their doctor to discuss the risks and benefits of active surveillance versus immediate treatment.