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Prostate Cancer Overtreated?
Study Shows ‘Watchful Waiting’ Strategy Not Used Enough
Feb. 22, 2007 (Kissimmee, Fla.) -- Fewer than one in 10 men with early prostate cancer and eligible to choose close observation rather than active treatment opts for that strategy, researchers report.
The findings suggest that many men at low risk of having their cancer spread may be overtreated, researcher Daniel Barocas, MD, of New York-Presbyterian Hospital-Weill Cornell Medical Center in New York, tells WebMD.
The study looked at 1,886 men with prostate cancer.
About 16% had early cancer that was contained within the prostate and at very low risk of spreading -- and therefore were eligible to undergo the strategy of "watchful waiting," which involves close monitoring of the tumor growth.
But only 9% opted for that approach, says Barocas.
The study was presented at the 2007 Prostate Cancer Symposium, co-sponsored by the American Society of Clinical Oncology, the American Society for Therapeutic Radiology, and Oncology, and the Society of Urologic Oncology.
The Watchful Waiting Debate
"To treat" or "not to treat" is one of the most difficult dilemmas facing men with prostate cancer, especially those with a small cancer contained within the prostate and curable.
Because prostate cancer often grows so slowly it may never become life-threatening, many of these men, particularly older men, may die of other causes before the cancer causes a problem.
But in some men, the cancer will spread beyond the prostate without treatment. Then it may no longer be curable.
As a result, there has been a long-running debate in the medical community about the value of treatment to destroy cancer cells versus watchful waiting, also known as active surveillance.
Treatment usually involves surgical removal of the prostate or radiation therapy.
Watchful waiting consists of close monitoring with periodic digital rectal exams, biopsies, and PSA (prostate-specific antigen) blood tests. Rising PSA levels can be a sign of prostate cancer spread in men with early cancer.
Watchful Waiting More Common in Older Men
For the study, the researchers analyzed data from a large, national registry of men treated for prostate cancer.
They found that older men were much more likely to opt for watchful waiting than younger men: Those over age 70 were 26 times more likely to choose the strategy than those younger than 63.
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