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Prostate Cancer and 'Watchful Waiting' Approach

European study tracked how many men came back for regular checkups over 13 years

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The study highlights the need for doctors to impress upon prostate cancer patients the importance of checkups, said Dr. David Samadi, chairman of urology at Lenox Hill Hospital, in New York City.

"The patient must be willing to have regular follow-ups that will consist of regular PSAs [blood tests for prostate-specific antigen], physicals and ultrasounds to closely watch if the cancer is progressing, resulting in long-term follow-ups with close surveillance," Samadi said. "Compliance from the patient throughout the whole process is a must, as watchful waiting can lead to metastasis and spread to other organs."

Dropout rates are probably even worse in the United States than in Switzerland, said Dr. Otis Brawley, chief medical officer for the American Cancer Society.

Men in the United States face more difficulty finding transportation to the doctor, may not be able to afford the co-pays required for each visit or might lose their insurance during active surveillance, Brawley said.

Prostate cancer patients also might put their condition on the back burner because they are facing other, more critical medical issues, or just don't want to hassle with invasive probes on a regular basis, he said.

On the other hand, Brawley said, the new study actually is a success story for active surveillance, in that three-fourths of the men who kept their appointments never needed treatment.

"It's a glass-half-full, glass-half-empty situation," he said. "I look at the same data and say aha, there were a large proportion of men who stayed in follow-up and never got treated, and that's good."

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

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