“Watchful waiting” often works for prostate cancer

New research indicates that over half of men who choose “watchful waiting” as the initial strategy for prostate cancer need no treatment over the long haul.

With “watchful waiting,” patients with early prostate tumors are monitored regularly and only treated if their cancer progresses.

“Patients and doctors should not assume that any/all cancer must be immediately treated,” lead researcher Dr. Martin G. Sanda, from Beth Israel Deaconess Medical Center, Boston, told Reuters Health.

“Some very early tumors, such as prostate cancers that have the lowest risk profile, can safely be monitored and their treatment can be reserved for those that show growth during the subsequent monitoring period,” she added.

Sanda’s team investigated 3331 men diagnosed with prostate cancer from 1986 to 2007. Of these patients, 342 (10.3 percent) selected deferred treatment (watchful waiting), defined as not receiving treatment for more than 1 year after diagnosis.

During an average follow-up of 7.7 years, 174 (51 percent) of the deferred treatment patients remained untreated. For the remainder, treatment began 3.9 years after diagnosis, on average.

The rate at which prostate cancer spread beyond the organ was similar among the deferred treatment group and the immediate treatment group. Likewise, rates of death from prostate cancer were no different with deferred and immediate treatment.

The findings appear in the Journal of Clinical Oncology.

In a related commentary, Dr. Anthony Zietman, from Massachusetts General Hospital in Boston, says these findings add “to the body of evidence reassuring physicians that it is safe to observe before treating many men with localized disease.”

“I am optimistic that we can break our cultural addiction to immediate treatment for all and move toward discriminating, selective, and more socially responsible behavior in this challenging disease,” Zietman writes.

SOURCE: Journal of Clinical Oncology, 2009.

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