Watch and Wait a Safe Approach for Prostate Cancer

2 min read

March 12, 2023 – Actively monitoring early-stage prostate cancer offers the same long-term survival rate as having surgery or radiation to treat the cancer, according to a new study. The option will allow many men to avoid treatment side effects that can cause problems with urinary, bowel, and sexual function.

“It’s clear that, unlike many other cancers, a diagnosis of prostate cancer should not be a cause for panic or rushed decision making,” lead researcher Freddie Hamdy, MD, a professor of surgery and urology at the University of Oxford in England, said in a statement. “Patients and clinicians can and should take their time to weigh up the benefits and possible harms of different treatments in the knowledge that this will not adversely affect their survival.”

The results were published Saturday in the New England Journal of Medicine and presented at a meeting of the European Association of Urology. The study evaluated three different courses of treatment among more than 1,600 men living in the United Kingdom. These men were newly diagnosed with localized prostate cancer between 1999 and 2009. The men either received radiation treatment, had surgical removal of all or part of the prostate gland, or were actively monitored via laboratory bloodwork. The men ranged in age from 50 to 69 years old, and the median age at diagnosis was 62. They were followed for 15 years following diagnosis.

Overall, 3% of the men in the study died from prostate cancer, and the rate was similar regardless of whether they received treatment or monitoring. 

Prostate cancer is the second most common cancer among men in the U.S., killing 33,000 men in 2020. The prostate gland is part of the male reproductive system and is located just below the bladder. It’s the size of a walnut and surrounds the urethra, which is the tube that empties urine from the bladder. The prostate gland produces fluid that is part of semen.

In the study, men who received active monitoring were twice as likely to have their cancer spread, compared to those in the two treatment groups. Yet the monitoring group still had a 15-year survival rate of 97%, which was the same as the two treatment groups. At the end of the 15-year follow-up period, about one-quarter of the men in the monitoring group had not received any invasive treatment.

“The fact that the greater progression of disease seen under active monitoring didn’t translate into higher mortality will be both surprising and encouraging to urologists and patients,” said Peter Albers, MD, chair of the EAU’s Scientific Congress Office and a urologist at Düsseldorf University in Germany. “Active monitoring and biopsy protocols today are much more advanced than at the time this trial was conducted, so it’s possible we could improve on these outcomes still further. It’s an important message for patients that delaying treatment is safe, especially as that means delaying side effects as well.”