US researchers, revealing the results of a study on prostate cancer at a meeting of specialists in San Francisco this week, suggested that watch and wait is a safe option for older men with early stage prostate cancer because they are not likely to die from the disease.
The study was carried out by Dr Grace Lu-Yao of the Cancer Institute of New Jersey, and colleagues and was sponsored by the US National Cancer Institute.
According to Reuters news agency, the source of the story in many newspapers and internet media, these findings support the belief held by many cancer specialists, that prostate cancer is rarely a killer when it strikes late in life.
Lu-Yao and colleagues found that of 9,000 men aged 70 and over with low to moderate grade prostate cancer tumours, only 3 to 7 per cent died within 10 years of diagnosis.
Lu-Yao said in a press statement that:
“Because prostate cancer therapies are associated with significant side effects, our data can help patients make better informed decisions about the most appropriate approach for them and potentially avoid treatment without adversely affecting their health.”
However, choosing not to have treatment does not mean you forget about it. The researchers said it was also important to keep a close eye on patients who chose not to be treated, to make sure the cancer does not suddenly become aggressive and spread.
Part of the shift toward watchful waiting comes because prostate cancer can take over a decade to develop after the early signs are detected. Before screening techniques such as the PSA test (detects changes in the prostate specific antigen levels), men first became aware of having the disease when physical symptoms due to the enlarged prostate started to have effect. By this time the cancer could be quite advanced.
Now with the PSA test, doctors are finding out much earlier, and the treatment options become broader, including wait and see, or “watchful waiting” as it has also been called.
In Lu-Yao’s study, 2,675 of the men did eventually have treatment, which comprised either surgery, hormone therapy, chemotherapy or radiation therapy. But they waited for about 10 years on average.
The treatment for prostate cancer is especially tough on the older man. So the watchful waiting has to be balanced against whether the patient will withstand the operation if he waits much longer. Many patients experience bladder and sexual difficulties after surgery.
Another study is also being presented at the meeting, which is sponsored by the American Society of Clinical Oncology, and other cancer related organizations.
This study showed that radiation treatment can extend survival in men who have had their prostates removed. By monitoring their PSA levels after surgery, doctors can see if the cancer has returned and then treat it with radiation. This is called “salvage” radiation, and it lessened the risk of dying from prostate cancer by more than 60 per cent, said the researchers who are based at the Johns Hopkins University School of Medicine in Baltimore.
After lung cancer, prostate cancer is the second biggest cancer killer of men. According to the National Cancer Institute, over 218,000 American men were diagnosed with prostate cancer and over 27,000 died from it in 2007.
Sources: Reuters, The Canadian Press.
Written by: Catharine Paddock, PhD