Watchful Waiting OK for Prostate Cancer
Study Backs Strategy of Skipping Treatment for Older Men With Early-Stage Disease
WebMD News Archive
Feb. 13, 2008 -- Most older men with early-stage prostate cancer can safely choose close observation
instead of active treatment and all of its potential side effects, a new study
Researchers examined data on more than 9,000 older men with localized
prostate cancer who were not initially treated for the disease.
Ten years later, about four-fifths were alive without any complications of
their disease or had died of other causes.
The findings support a strategy of "watchful waiting" -- close
monitoring for signs of tumor growth -- in many older men, says researcher
Grace Lu-Yao, PhD, a cancer epidemiologist at The Cancer Institute of New
Jersey and an associate professor at the University of Medicine and Dentistry
of New Jersey-Robert Wood Johnson Medical School and School of Public
"Currently there is no effective tool to determine who needs
treatment," Lu-Yao tells WebMD. "Our data will help patients to know
what will happen if they don't have treatment."
The Watchful-Waiting Debate
To treat or not to treat is one of the most difficult dilemmas facing men
with prostate cancer, especially those with localized cancer that is contained
within the prostate, when it is curable.
Because prostate cancer often grows so slowly it may never become
life-threatening, many of these men, particularly older men, may die of other
causes before the cancer causes problems. But in some men, the cancer will
spread beyond the prostate without treatment. Then it's no longer curable.
As a result, there has been a long-running debate in the medical community
about the value of treatment to destroy cancer cells vs. watchful waiting, also
known as active surveillance.
Treatment usually involves surgical removal of the prostate or radiation
therapy. Impotence, urinary incontinence,
and bowel problems are all potential side effects of the most widely used
treatments for prostate cancer.
Watchful waiting consists of close monitoring with periodic digital rectal
exams, biopsies, and PSA (prostate-specific antigen) blood tests. Rising PSA
levels can be a sign of prostate cancer spread in men with early cancer.
Lu-Yao says the new study is one of the first to describe the natural
history of prostate cancer during the current era when PSA testing is common.
This is important because PSA tests can help detect cancer six to 13 years
earlier than traditional diagnostic methods, she says.
In contrast to older studies, the current trial also included a large number
of elderly patients. More than 5,000 participants were over age 75, she
"This is the group of patients most likely to benefit from active
surveillance but for whom little is known due to lack of data," Lu-Yao
The findings will be reported this week at the Genitourinary Cancers
Symposium (GSC) in San Francisco.