Rethinking when to biopsy

According to a study in the Archives of Internal Medicine, a prostate cancer diagnosis may send a man to the operating room or drive him to get radiation therapy—even when the cancer is unlikely to spread or cause harm.

Using data from a large national cancer registry, researchers looked at treatment choices of more than 123,900 men diagnosed with prostate cancer between 2004 and 2006. Of these patients, 14% had prostate-specific antigen (PSA) levels below 4 ng/mL, and more than half of those patients had low-risk disease. Despite being less likely to develop aggressive tumors, they were just as likely to undergo radiation or surgery as men with more active tumors and PSA levels between 4 and 20 ng/mL.

Although effective, surgery and radiation therapy are costly procedures that can lead to serious side effects, including incontinence and erectile dysfunction. Such complications may offset the intended benefit of treating the cancer, which might never have caused harm.

The researchers conclude that conservative treatment may be more appropriate for men with low PSA levels. They also note that performing biopsies on men with a PSA below 2.5 ng/mL may increase the risk of being diagnosed with prostate cancer and needlessly receiving treatment.

SOURCE: Shao YH, Albertsen PC, Roberts CB, et al. Risk Profiles and Treatment Patterns Among Men Diagnosed as Having Prostate Cancer and a Prostate-Specific Antigen Level Below 4.0 ng/mL. Archives of Internal Medicine 2010;170:1256-61. PMID: 20660846.

Originally published September 2010; last reviewed March 2, 2011.