Prostate Cancer: Early Surgery or Watchful Waiting?
Study Shows Early Surgery Cuts Deaths From Low-Risk Prostate Cancer
Prostatectomy for Low-Risk Prostate Cancer? continued...
Smith notes that in the Swedish study, 88% of the men had tumors that could be felt on a rectal exam, and only about 5% had their cancer detected via PSA screening tests. In the U.S. today, fewer than half of men diagnosed with prostate cancer have tumors that can be felt on a rectal exam, and most cancers are detected via PSA screening.
This means that today, most prostate cancers are diagnosed seven to 10 years earlier than they were when the men in the Swedish study were diagnosed.
"Since these cancers were not well represented in the Scandinavian study, we cannot generalize from this to say men diagnosed with low-grade cancer today would derive the same benefit. We still don't know if we have to treat all of those men," Smith tells WebMD.
But Smith agrees with Bill-Axelson that immediate treatment isn't necessary for all of these men. When a patient's biopsy shows that a prostate tumor has a low grade, and that tumor volume is small, the patient is a likely candidate for active surveillance.
For some doctors, "active surveillance" differs a bit from "watchful waiting" in that the tumor is carefully monitored, with repeat biopsies as necessary, so that a patient gets appropriate treatment as soon as the cancer progresses -- but well before it becomes a high-risk tumor.
"We do enthusiastically recommend active surveillance in carefully selected patients," Smith says. "This is not to say, 'Have surgery or go off on your own.' It is actively monitoring men with low-risk disease and selectively intervening when there is sufficient information about the cancer to justify treatment."
Men worried about prostate cancer and the doctors who treat the disease would love to have a lot more information about prostate cancer, a better screening test, and treatments with fewer side effects. But Smith insists that treatment plans can be optimized for each patient.
"We can individualize patient decisions," Smith says. "We may not have all the information we need, but we can still make good decisions."