Is watchful waiting (close monitoring rather than immediate surgery) for low-grade prostate cancer a safe alternative? New research from the Journal of the National Cancer Institute offers guidance.
Today watchful waiting for prostate cancer is most often recommended for men with low-grade prostate cancer that is believed to be small volume, especially older men whose prostate cancer is unlikely to become life threatening during their remaining years of life.
Men who choose watchful waiting must see their doctor regularly and undergo testing to determine whether the cancer is progressing. Recommendations on the frequency of visits and the tests conducted each time vary from doctor to doctor. Johns Hopkins recommends the following guidelines for men age 75 and younger who are in otherwise good health: PSA testing and a digital rectal exam twice a year and transrectal ultrasound and prostate biopsy once a year. The recommendations for PSA testing and digital rectal exams remain the same after age 75, but yearly ultrasound and prostate biopsy are no longer routinely performed.
Now new research reported in the Journal of the National Cancer Institute (Volume 98, page 355) indicates the delayed treatment is indeed safe for low-grade prostate cancers. Johns Hopkins researchers have provided solid evidence from a comparative study that delaying prostate cancer surgery for 26 months or more does not compromise curability. They assessed the outcomes of men thought to have small-volume low-grade cancers: 38 men who did choose expectant management as well as 150 men who had surgery immediately, within about three months of diagnosis.
Men in the expectant-management group had digital rectal exams, measurements of total and free PSA twice a year, and a yearly prostate biopsy. An ominous prostate biopsy finding or the patient’s request for treatment triggered a move to surgery.
The risk of prostate cancer recurrence (based on the pathology findings at surgery) after at least two years proved similar in the two groups, the researchers report. Their conclusion: For a low-risk prostate cancer patient, opting to watch and wait is not, in fact, a risky decision.
