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

It has been suggested that, in terms of health benefits for the patient, aggressive treatment of early prostate cancer can reflect a poor quality of care, equivalent to failing to treat the cancer at all. In recognition of the growing evidence in support of expectant management for men with early prostate cancer, Miller and colleagues used population data to estimate the potential burden of overtreatment in patients with newly diagnosed prostate cancer.

This retrospective cohort study included data from 13 US registries on 71,602 men who were diagnosed with localized or regional adenocarcinoma of the prostate in 2000–2002. The primary aim was to quantify the incidence of initial curative therapy (e.g. radiation or surgical treatment) among men with prostate cancers who were defined as low risk on the basis of specific age and grade criteria.

Complete data for the first course of treatment were obtained for 24,405 men with low-risk prostate cancer; 45% received radiation therapy, 10% underwent radical prostatectomy, and 55% received initial curative treatment and had, therefore, been overtreated. The greatest risk of overtreatment with radical prostatectomy in the low-risk group was in men <55 years of age with well-differentiated tumors. Men in the low-risk group who were aged 70–74 years with moderately differentiated tumors had the highest risk of being overtreated with radiotherapy.

This study indicates that greater use of expectant-management approaches in patients with low-risk prostate cancer could reduce overtreatment and improve quality of care.