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Prostate Cancer and 'Watchful Waiting' Approach

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

continued...

However, another 27 percent of the men in the study didn't bother coming back for check-ups after being placed on active surveillance, leaving themselves potentially vulnerable to a prostate cancer flare-up.

Researchers also found that about 19 percent of the men refused to undergo a second biopsy three months after their diagnosis, to confirm the results of their first prostate cancer biopsy.

"We don't know exactly what the reasons are," Hefermehl said. "It may be that once the patient was told that this cancer is probably 'not immediately threatening,' he might downplay the importance of another test.

"On the other hand, some men might have real concerns about the risk of there being a more severe cancer," he said. "Or it may be to do with the risk of incontinence or impotence after treatment, the idea of having cancer, a sense that nothing will really happen to them or it may be due to another reason which we just don't know about."

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.

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