Taking a watch-and-wait approach to prostate cancer, rather than attempting to remove the cancer, is a safe approach and doesn't lead to more deaths, concludes a new analysis.
The study, in the Journal of Clinical Oncology, finds that patients with early-stage, slow-growing prostate cancers are not taking a risk if they choose to let their doctors simply "keep an eye" on their disease, rather than treat it right away.
For the study, researchers at the Odette Cancer Centre at Sunnybrook Health Sciences Centre in Toronto, reviewed the medical records of more than 450 prostate patients who were considered of "favourable risk" -- meaning their cancer was not considered aggressive or fast-growing. All were being managed with the watchful waiting approach called "active surveillance."
The men were followed for up to 13 years, with the median follow-up time being 6.8 years.
The researchers found that the rate of prostate cancer survival among the group was 97.2 per cent. Of the patients who did die during the study period, most died of causes other than prostate cancer.
In fact, at 10 years, the likelihood of death from something other than prostate cancer was 18.6 times greater than death from prostate cancer. In other words, patients in the study were more likely to die with prostate cancer than to die of prostate cancer.
"We hope this mature data will help quell resistance to the approach of active surveillance, which is aimed at reducing overtreatment and radical treatment side effects in men with low-grade prostate cancer," said Dr. Laurence Klotz, the lead author of the study and the head of the Genitourinary Cancer Care team at Odette.
When 66-year-old Gary Dailey discovered he had prostate cancer five years ago, he thought it would require surgery.
"The word cancer, to anyone, is terrifying," he told CTV News.
But he spoke with another prostate cancer patient who had been treated by Klotz. Now, Dailey is tested about every six months to make sure the cancer is not life-threatening.
"It's not growing. Hopefully I'll die from other causes," he said.
Many doctors prefer to take a "watchful waiting" approach to low-risk forms of prostate cancer because years of research has shown that the risks of many cancer treatments outweigh the benefits the treatments might provide. For example, surgery and radiation have high likelihoods of leaving patients incontinent, impotent, or both.
Active surveillance, meanwhile, means having patients go for regular PSA (prostate specific antigen) testing and watching the PSA doubling time, as well as periodically having the patient undergo biopsies. Doctors then treat only those patients whose cancer is reclassified over time as higher risk. In this study, 30 per cent of the patients were reclassified during the study period.
Klotz noted that earlier this year, a large, landmark study out of Europe found that there are benefits of using universal PSA screening to reduce death from prostate cancer. But the study also found a significant risk of overtreatment.
"This dilemma is the rationale for a more individualized approach through active surveillance with selectively delayed intervention based on predefined criteria of disease progression for favorable risk patients," says Klotz.
In 2009, an estimated 25,500 Canadian men will be diagnosed with prostate cancer and about 4,400 will die of the disease.
With a report by CTV's Scott Laurie in Toronto
