Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Viewpoint
  • Published:

Early versus delayed intervention for prostate cancer: the case for early intervention

Nature Clinical Practice Urology volume 4, pages 348–349 (2007)Cite this article

Before the availability of PSA testing as a first-line screening method,1 most prostate cancers were diagnosed incidentally in prostate tissue removed during transurethral resection for presumed benign disease, or through abnormal findings on digital rectal examination (DRE) of the prostate. Owing to the lack of a good method for early detection, as recently as 1985 to 1989 16% of patients had metastatic disease at the time of diagnosis.2 Since the introduction of widespread PSA-based screening, there has been a striking stage migration. According to data from the Surveillance, Epidemiology, and End Results (SEER) program, at least 96% of men are now diagnosed with local or regional disease, and 5-year relative survival rates have increased from about 75% to nearly 100%.3

However, PSA testing has fallen victim to its own success, as there is now concern that prostate cancer is being overdiagnosed, leading to the unnecessary treatment of indolent tumors that may have not otherwise caused harm. For example, Miller et al. recently used SEER data to estimate that in 2000 to 2002, 2,564 (10%) and 10,973 (45%) low-risk patients were overtreated with radical prostatectomy and radiation therapy, respectively.4 An important limitation of the Miller study was that men were categorized into risk groups based only upon Gleason score, without taking into account other important prognostic variables, such as the PSA level at diagnosis, PSA kinetics, clinical stage, or any measurement of cancer volume from the biopsy specimen. As with other epidemiological studies, the Miller analysis does not reflect the spectrum of individual variables that affect treatment decisions in any given patient. Nevertheless, this and other studies highlight the growing concern about the potential overtreatment of low-risk prostate cancer.5

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Catalona WJ et al. (1991) Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med 324: 1156–1161

    Article  CAS  Google Scholar 

  2. Surveillance, Epidemiology, and End Results (SEER) Program (online April 2006) SEER*Stat Database: Incidence—SEER 17 Regs Public-Use, Nov 2005 Sub (1973-2003 varying), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch. Released April 2006, based on the November 2005 submission. [www.seer.cancer.gov] (accessed 28 August 2006)

  3. American Cancer Society. Cancer Facts and Figures 2007 [http://www.cancer.org/downloads/STT/CAFF2007PWSecured.pdf] (accessed 5 May 2007)

  4. Miller DC et al. (2006) Incidence of initial local therapy among men with lower-risk prostate cancer in the United States. J Natl Cancer Inst 98: 1134–1141

    Article  Google Scholar 

  5. Postma R et al. (2007) Cancer detection and cancer characteristics in the European Randomized Study of Screening for Prostate Cancer (ERSPC)—Section Rotterdam: a comparison of two rounds of screening. Eur Urol [doi: 10.1016/j.eururo.2007.01.030]

    Article  Google Scholar 

  6. Choo R et al. (2002) Feasibility study: watchful waiting for localized low to intermediate grade prostate carcinoma with selective delayed intervention based on prostate specific antigen, histological and/or clinical progression. J Urol 167: 1664–1669

    Article  Google Scholar 

  7. Carter HB et al. (2002) Expectant management of nonpalpable prostate cancer with curative intent: preliminary results. J Urol 167: 1231–1234

    Article  Google Scholar 

  8. Freedland SJ et al. (2006) Delay of radical prostatectomy and risk of biochemical progression in men with low risk prostate cancer. J Urol 175: 1298–1302

    Article  Google Scholar 

  9. Antenor JA et al. (2005) Preoperative PSA and progression-free survival after radical prostatectomy for Stage T1c disease. Urology 66: 156–160

    Article  Google Scholar 

  10. Kundu SD et al. (2004) Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. J Urol 172: 2227–2231

    Article  Google Scholar 

  11. Bill-Axelson A et al. (2005) Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 352: 1977–1984

    Article  CAS  Google Scholar 

  12. Wong YN et al. (2006) Survival associated with treatment vs observation of localized prostate cancer in elderly men. JAMA 296: 2683–2693

    Article  CAS  Google Scholar 

  13. Loeb S et al. (2006) Pathological characteristics of prostate cancer detected through prostate specific antigen based screening. J Urol 175: 902–906

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. S Loeb is a Resident in Urology at Georgetown University School of Medicine, Washington DC, and WJ Catalona is a Professor of Urology and Director of the Clinical Prostate Cancer Program, Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,

    Stacy Loeb & William J Catalona

Authors
  1. Stacy Loeb
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William J Catalona
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to William J Catalona.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Loeb, S., Catalona, W. Early versus delayed intervention for prostate cancer: the case for early intervention. Nat Rev Urol 4, 348–349 (2007). https://doi.org/10.1038/ncpuro0838

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpuro0838

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing