Utilization Of Deferred Treatment/Watchful Waiting Among Prostate Cancer Survivors In The Physicians Health Study

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 11 Jun 2008 - 8:00 PDT

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ORLANDO, FL (UroToday.com) - Given significant morbidity and cost of prostate cancer treatment, overtreatment of the disease is a significant public health concern. Watchful waiting and active surveillance protocols are being implemented more frequently and are becoming a widely accepted management option both for patients diagnosed with low risk disease and those in whom significant co-morbidities compete with prostate cancer for life-expectancy.

Do we know how often and in which group of patients has this therapeutic option been utilized by physicians? Shappley et al. report data on deferred management of prostate cancer from the Physicians' Health Study - a large prospectively maintained nationwide database. From 1982 to 2004, 2,587 cases of CaP were identified. In 2003-2005, the authors collected treatment information from 1,288 survivors.

Deferred therapy was defined as a delay in definitive treatment for over 1 year. Not surprisingly, patients managed with delayed treatment were older (71.1. vs 67.9 yrs) and had lower risk disease. 38% of patients who initially started on watchful waiting were left untreated at the mean follow-up of 7 years.

When rates of metastatic progression were compared between patients who elected deferred treatment and those who were treated immediately, no statistical differences were seen. Clearly this comparison involves patient groups at a very different risks of disease progression; nevertheless, it is reassuring.

It will be important to continue close assessment of watchful waiting/active surveillance protocols, as this management strategy is more widely accepted and begins to incorporate younger patients.

Presented by William V Shappley, MD, Julie L Kasperzyk, MD, Stacey A Kenfield, MD, Lorelei A Mucci, MD, Julia Fleet, MD, Tobias Kurth, MD, Jing Ma, MD, Meir J Stampfer, MD, and Martin G Sanda, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Alexander Kutikov, MD

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