Prostate Cancer Prostate Cancer Treatment

Waiting to Treat Prostate Cancer?

It is common practice to manage some cases of prostate cancer with a sit-back-and-watch approach rather than aggressive treatment. Prostate cancer tends to grow and spread very slowly, and radiation or surgical treatments may cause a range of side effects, such as sexual dysfunction or bladder problems.

As a result, doctors often advise older patients or those with other illnesses to defer treatment until absolutely necessary. But a new study seems to indicate that even older men with prostate cancer live longer when their cancer is treated.

"Our findings show that despite the slow-growing nature of low and intermediate risk prostate cancer, treating patients may help them live longer, even among older men," said Dr. Yu-Ning Wong from the Fox Chase Cancer Center in Philadelphia in a press release.

Looking at almost 50,000 men from a Medicare registry who were diagnosed with prostate cancer after 1990, Wong noted at a meeting of the American Society of Clinical Oncology that over 14,500 chose "watchful waiting" and over 34,000 chose to pursue treatment in the form of surgery or radiation. By the end of the study—13 years later—59 percent of the men who pursued treatment were still alive, compared with only 27 percent from the other group.

This study is not the final word on whether older patients should be treated aggressively. Those who choose watchful waiting tend to be sicker in the first place and simply cannot withstand aggressive treatment, experts caution. Co-investigator of the study, Dr. Gary Hudes, emphasized that the study was conducted to address this concern but still admitted that illness, "could be a confounding factor that would make you wonder about the results."

Still, the findings are bound to add to the heated debate on the merits of watchful waiting. For the most part, it seems, a man who is under the age of 65 with prostate cancer benefits from surgery to remove the cancer. Older men are more likely to die with prostate cancer than from it, so there is less reason to go through treatment. For these men—and those who have less aggressive tumors—a watchful waiting approach has become somewhat normal, as doctors can monitor the growth of the cancer and take action only when things seem to be getting worse.

"Some prostate cancers grow so slowly that they never become life-threatening, especially in elderly men who may die of other causes before the cancer causes problems," said Wong. "But other men develop complications and die from their cancer, making the decision to treat quite difficult."

The results of this study highlight the fact that doctors and patients need to consider all factors when discussing treatment options for prostate cancer.

"The take-home message is that for men who have a reasonable life expectancy, treatment should be considered," said Hudes. "You should think long and hard about watchful waiting before deciding that it is right for you."