Prostate Cancer: No Treatment OK for Some
Outcomes Good With Active Surveillance, New Study Suggests
March 19, 2009 -- The best treatment may be no treatment at all for some
younger men with early stage, good-prognosis prostate cancer, new research
Known as active surveillance or watchful waiting, the strategy of intensive
monitoring instead of treatment is mostly reserved for elderly patients with
other health problems who are likely to die of some other cause before their
prostate cancer spreads.
The thinking has been that the approach may be too risky for younger men who
may live with prostate cancer for decades instead of a few years.
But a new study shows active surveillance to be a viable option for
carefully selected prostate cancer patients, regardless of their age, as long
as they are closely followed to make sure their disease does not progress.
Of the 262 men in the study who were initially observed but not treated
after being diagnosed, 43 ended up needing treatment over an average follow-up
of about 30 months and one patient died after his cancer spread to his
“There is definitely a risk to this strategy,” University of Chicago
urologist and lead researcher Scott E. Eggener, MD, tells WebMD. “What we were
able to do in this study was quantify this risk, and it appears to be very
Prostate Cancer Without Treatment
Eggener made it clear that not all prostate cancer patients with early-stage
disease and a good prognosis are good candidates for active surveillance.
In the United States, one man in six will receive a diagnosis of prostate
cancer during his lifetime, but a much smaller percentage -- one in 35 -- will
die from the disease, according to the American Cancer Society.
Surgery and radiation therapy save lives, but they also carry the risk of
serious long-term side effects, including incontinence, bowel problems, and
“Some men may be rushing into treatment that won’t necessarily benefit them,
prevent problems, or prolong life,” Eggener says. “Close observation in certain
patients may maintain quality of life without increasing the chances of the
The newly reported study included 262 prostate cancer patients recruited
from four treatment centers in the United States and Canada between 1991 and
All the men were younger than 75 at recruitment, with the average age being
64. All had early-stage, localized disease and all had the most favorable
biological disease markers, including a prostate-specific antigen (PSA) score
of below 10 ng/mL and a Gleason score of 6 or below.
Instead of having one biopsy to determine eligibility for active
surveillance, the patients had two. The second biopsy was done between 3.7-10.5
months after the first biopsy. As a result of the second biopsy, about 30% of
the patients who were initially considered candidates for surveillance were
excluded from the study because they ended up undergoing treatment.
“We feel that the second biopsy was an important step in identifying
patients who are not good candidates for active surveillance,” Eggener