If you or a loved one are sweating out the watch-and-wait approach that most men are subjected to when told they have prostate cancer, findings of a new study may either put you at ease or spur you to demand more from your doctor. The worldwide standard has been watch-and-wait for men who are considered to be at low risk for development of advanced prostate cancer—cancer that spreads beyond the prostate gland to nearby tissues, lymph nodes, bones or other parts of the body. Although this approach is also prescribed for many men considered to be at intermediate risk for advanced cancer, a debate has been ongoing among cancer specialists about whether that is appropriate or if it unnecessarily puts their lives in danger. A report recently presented at a major medical meeting of cancer specialists clears the air, and the information will be a decision-making boon if you are living with prostate cancer.
WILL THE WAIT KILL YOU?
As you may know, prostate cancer is generally slow-growing…so slow-growing that most men with prostate cancer die of other causes before the cancer gets to them. Depending on the cancer’s size and factors such as age, genetics and levels of prostate-specific antigen (a marker of prostate inflammation or cancer) in the blood, a watch-and-wait approach, also known as active surveillance, is recommended over more aggressive treatments in some but not all men at intermediate risk. After all, prostate cancer treatment comes with its own challenges in terms of side effects and quality of life, including, potentially, erectile dysfunction and urinary and/or bowel incontinence. The watch-and-wait approach involves regular physical exams, digital rectal exams, tests that measure prostate-specific antigen and repeat tumor biopsies. But new research shows that this level of scrutiny is not enough when it comes to intermediate-risk disease.
The researchers, who reported their findings at the Genitourinary Cancers Symposium in Orlando, showed that a meaningful difference in survival exists between men at low and intermediate risk who opt for watchful waiting. Researchers studied 708 men with low-risk cancer and 237 with intermediate-risk cancer and looked at their 10- and 15 year-survival rates. At 15 years, 3.7% of the men who had been deemed at low risk for advanced prostate cancer had died of prostate cancer…but 11.5% of men who had been deemed at intermediate risk had died of prostate cancer.
What do these numbers tell us about watchful waiting? First, they confirm that the watch-and-wait approach is effective for men with low-risk prostate cancer—with a long-term survival rate of 96%. But although it is effective for the large majority of men with intermediate-risk disease, it does seem that the survival rate for them (about 89%) could be improved.
HOW TO BETTER ENSURE YOUR SURVIVAL
The study authors concluded that more research needs to be done to precisely identify which types of patients with intermediate-risk disease would do well on watchful waiting (and, thereby, avoid being overtreated for prostate cancer), and which should receive treatment in the form of surgery or radiation therapy.
But what about you, right now, if you are given a diagnosis of intermediate-risk prostate cancer and a watch-and-wait approach is recommended by your physician? Get a thorough explanation of why your doctor thinks this is the best choice and the risks and benefits of your other treatment options. The choice between watchful waiting and treatment is always yours. If you decide to watch and wait, you can also discuss more frequent monitoring, getting an MRI to help guide exactly where in the prostate a biopsy should be taken or undergoing genetic testing to further clarify your risk.