But the information in the study shouldn't be applied to younger men, Lu-Yao stressed. The best available data indicate better survival with treatment for men under 65, she said.
So, the study might send the wrong message about PSA testing to those men, said Dr. Richard Greenberg, chief of urologic surgery at the Fox Chase Cancer Center in Philadelphia.
"My concern is that 50-year-old men with family histories of prostate cancer will be listening to these statements that there is too much screening, so they won't have screening because they think it isn't necessary," Greenberg said.
He is skeptical about watchful waiting, except in carefully selected cases. "I don't think anyone under 60 is a great candidate for watchful waiting unless they have another condition that is going to do them in within 10 years," Greenberg said.
Every man diagnosed with prostate cancer should understand that watchful waiting is one possible option, he said. "But you have to individualize the decision for every patient," Greenberg said. "If they have an aggressive cancer, they should be treated aggressively. You need to be very selective when you say when a conservative approach is appropriate."
Treatment or watchful waiting for cancer in men 70 and older "is an important question, but probably not the most important question," said Dr. Martin Sanda, director of the prostate cancer center at Beth Israel Deaconess Hospital in Boston.
Sanda recently reported a study of younger men whose average age when they were diagnosed with prostate cancer was about 60. That study indicated that "lower-risk tumors probably can be managed with watchful waiting in men anywhere from the 40s to the 70s," Sanda said, but the key issue is the nature of the tumor.
"For patients with poorly differentiated tumors, there is a fair amount of cancer deaths unless they are treated agg
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