New Data on “Watch & Wait” Treatment Strategy for Prostate Cancer

As bad as breast cancer is, at least women aren’t being told that they should just live with it — they get treatment. For many men with prostate cancer, the decision about how to proceed is often less clear, with many doctors advocating a “let’s see what happens” type of approach.

Prostate cancer now often gets detected early, thanks to the PSA blood test. Most prostate cancer is slow-growing, however, and many men are diagnosed with it late in life, making it unlikely to present a serious threat to a man’s life or well-being. Because treating prostate cancer can result in lifelong side effects, including incontinence and impotence, in many cases doctors advise “watchful waiting” for older men with less aggressive tumors. But the idea of “watch and wait” or even agreeing to just have “active surveillance” (periodic checkups to see whether the cancer is progressing instead of treating the cancer aggressively) isn’t always a comfortable one. Perhaps it will help to know there is now evidence demonstrating that this might be the best decision an older man can make.

What the data says

Until this study, the data comparing treatment versus waiting to see how the cancer develops was dated indeed. It was done all the way back in the days before the PSA blood test was available, when the digital rectal exam was the way prostate cancer was detected. This meant that cancer wasn’t identified until a tumor had grown to be large enough that doctors could feel it. In this study from the Cancer Institute of New Jersey/University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School, researchers looked at records of 14,516 prostate cancer patients (average age 78) diagnosed between 1992 and 2002 who had received no curative therapy (surgery or radiation) for at least six months after they were diagnosed. Men with less aggressive prostate cancer (Gleason scores under 7) had less than 10% likelihood of dying from prostate cancer… while for those with the highest initial Gleason scores (8 to 10), the death rate climbed to 25.6%.

What To Make of This?

Study author Grace L. Lu-Yao, PhD, MPH, told me that the goal of the research was to provide balanced information in the form of data that is both current and correct. She agreed that aggressive treatment may be very appropriate for men who are younger and expected to live longer than 10 years — but it’s a far more nuanced decision for older men, especially those with low or moderate Gleason scores. Older men now have a clearer picture of their survival odds one way and another. It’s still not an easy decision, but at least it can now be a more informed one.