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Prostate Cancer: No Treatment OK for Some

Outcomes Good With Active Surveillance, New Study Suggests
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WebMD Health News
Reviewed by Louise Chang, MD

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 suggests.

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 bones.

“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 low.”

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 sexual dysfunction.

“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 cancer spreading.”

The newly reported study included 262 prostate cancer patients recruited from four treatment centers in the United States and Canada between 1991 and 2007.

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