Delayed Surgery May Be a Safe Treatment Alternative for Low-Risk Prostate Cancer
“Watchful waiting” has been proposed as an alternative treatment strategy in men diagnosed with low-risk ]]>prostate cancer]]> . With watchful waiting, men diagnosed with prostate cancer are monitored closely and treatment (i.e., surgery or radiation therapy) is delayed until symptoms worsen or the cancer begins growing more quickly.
A new study in the March 1, 2006 issue of the Journal of the National Cancer Institute compared the outcomes of men diagnosed with small, lower-grade (non-aggressive) tumors who had immediate surgery with those who had surgery after a period of watchful waiting. The researchers found that watchful waiting did not increase the risk of non-curable prostate cancer.
About the Study
This study included 38 men with small, lower-grade prostate cancer tumors who underwent surgery after an average of 26.5 months of watchful waiting. The researchers compared the outcomes of these men with those of a group of 150 men who also had low-risk tumors, but who had immediate surgery (within three months of diagnosis). The researchers determined the proportion of men in each group who had non-curable prostate cancer (defined as having a less than 75% chance of remaining recurrence-free for 10 years) at the time of surgery.
Overall, nine (23%) of the participants in the watchful waiting group and 24 (16%) in the immediate surgery group had non-curable cancer at the time of surgery. But when the researchers adjusted their analyses for age and, so-called, PSA density at diagnosis (both associated with worse prognoses), there was no difference in the risk of non-curable prostate cancer between the men in each group.
These findings are limited because the study only involved a small sample of men undergoing watchful waiting. Also, the classification of non-curable cancer was based on a risk assessment; a longer follow-up to determine which men actually had a recurrence would yield more reliable results.
How Does This Affect You?
These findings suggest that watchful waiting may be a safe alternative to immediate surgery in the treatment of men diagnosed with low-risk prostate cancers. This is important, since it is estimated that almost 50% of prostate cancer diagnoses are initially classified as low risk.
Men who are diagnosed with early-stage, lower-grade prostate cancer should be informed about the option of watchful waiting. Because prostate cancer often spreads very slowly, some older men may never require treatment for their cancer. And it appears that even if surgery does become necessary, waiting for at least two years after diagnosis may not compromise the curability of the cancer.
American Cancer Society
National Cancer Institute
Prostate Cancer Foundation
Warlick C, Trock BJ, Landis P, Epstein JI, Carter B. Delayed versus immediate surgical intervention and prostate cancer outcome. JNCI . 2006;98(5):355-357.
Last reviewed Mar 3, 2006 by ]]>Richard Glickman-Simon, MD]]>
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