When to Watch and Wait With Prostate Cancer

Prostate cancer may require only active surveillance

(RxWiki News) More men are aggressively treated for prostate cancer than is necessary to save a life from the disease, according to the Prostate Cancer Foundation. For men with low-risk cancer, careful monitoring may be preferred.

New research shows that, on average, men who choose an active surveillance approach to low-risk cancer have a life span that is only slightly shorter than those who choose surgery.

Scientists estimate that the difference is as little as two to three months.

Through active surveillance, or watchful waiting, doctors can regularly check the progression of a low-risk cancer.

Some men with low-risk disease, however, turn to surgery right away to eliminate the cancer.

"Consult with your doctor about treatments for prostate cancer."

Ruth Etzioni, PhD,a biostatistician in the Division of Public Health Sciences at the Fred Hutchinson Cancer Research Center in Seattle, and her colleagues compiled data from published studies to estimate mortality rates of men with low-risk cancer who chose a “watchful waiting” approach.

They compared these numbers with the mortality of men treated with immediate radical prostatectomy (removal of the prostate). They found that, on average, men who chose surgery did not live much longer than those who used watchful waiting.

Dr. Etzioni and fellow scientists projected that 2.8 percent of men who choose active surveillance would die from their disease within 20 years of their diagnosis compared with 1.6 percent of men who undergo immediate prostatectomy.

The patient undergoing surgery lives just under two months longer than the patient choosing watchful waiting.

The National Institutes of Health backs watchful waiting as a viable option and alternative to treatment.

Monitoring through watchful waiting usually includes a periodic digital rectal exam (DRE) and a PSA blood test. A PSA test measures prostate-specific antigens in the blood, and high levels may indicate the presence of cancer.

Doctors may also monitor low-risk prostate cancer patients by taking a tissue sample (biopsy) of the prostate. From a tissue sample, a doctor can evaluate a prostate tumor and determine if it is likely to be slow-growing or grow more aggressively.

The Prostate Cancer Foundation says that a low-risk patient may have a low PSA and a low stage of cancer.

“We are now diagnosing many more men with low-risk prostate cancer, and we are faced with the dilemma that not all of these men will benefit from treatment,” said Dr. Etzioni. “Very few men with low-risk disease die from prostate cancer, and the difference between treatments appears to be very modest.”

The researchers say that it is now important to measure the quality of life between these two groups. The Prostate Cancer Foundation says that surgery can be difficult for some men to endure. Some long-term side effects of surgery can be impotence and incontinence.

"Active surveillance means we’re going to pay attention to this disease because it can change from low-risk to intermediate- or high-risk,” said Brian J. Miles, MD, FACS, board-certified urologist at The Methodist Hospital in Houston, Texas. “For those of us who treat prostate cancer, we view active surveillance not as a question of if to treat, but basically when to treat. And hopefully when is never."

The study was published in September in Clinical Cancer Research, a journal of the American Association for Cancer Research.

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Review Date: 
September 25, 2012