Q: What is “conservative management” or “deferred treatment” and when are these approaches appropriate with regards to early low-grade prostate cancer?
A: Conservative management for clinically localized prostate cancer includes androgen-deprivation therapy and active surveillance (PSA checked every 6 months and biopsies every 1 to 3 years). In a study by Warlick et al. (J Natl Cancer Inst, 2006), researchers examined 38 radical-prostatectomy specimens taken from men with small, low-grade cancers who had received specific treatment after a long period of active surveillance, and compared these with specimens from men who had elected immediate prostatectomy. There was no difference in the frequency of higher-grade cancers, positive margins, or other adverse features between the two groups. The authors concluded that deferred treatment does not close the window on the chance for cure in selected patients.
Q: Why is finasteride a useful drug for men who have both benign prostatic hypertrophy and prostate cancer?
A: Finasteride is a useful drug for men who have both benign prostatic hypertrophy and prostate cancer and are undergoing active surveillance. It suppresses excess PSA production that is due to benign prostatic hyperplasia. Increases in PSA level while a patient is taking finasteride are therefore likely to be related to progressive prostate cancer.
Teaching topics from the New England Journal of Medicine - Vol. 358, No. 20, May 15, 2008