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Reprinted from the NCI Cancer Bulletin, vol. 5/no. 4, February 19, 2008 (see the current issue).
The vast majority of older men diagnosed with localized prostate cancer who initially forego treatment will die of something other than prostate cancer, researchers said last week. The finding supports the view that actively monitoring the cancer's progression until such time as treatment is needed - a strategy called watchful waiting - is a reasonable response to a diagnosis of early-stage disease for some men.
Using data from NCI's Surveillance, Epidemiology, and End Results (SEER) program, Dr. Grace Lu-Yao of The Cancer Institute of New Jersey and her colleagues asked what happened to 9,000 men who chose active surveillance rather than treatment in an era when screening with the prostate-specific antigen test increased.
After 10 years, 3 to 7 percent of those with low- or moderate-grade disease had died of prostate cancer, compared with 23 percent of men with high-grade cancers. The men were diagnosed between 1992 and 2002 and did not have treatment in the first 6 months after diagnosis. Half were over age 75.
Of the approximately 2,600 men who eventually underwent treatment for the disease, about half delayed therapy for more than a decade. Dr. Lu-Yao presented the results at the first Genitourinary Cancers Symposium in San Francisco, which was sponsored by the American Society of Clinical Oncology (ASCO) and other groups.
Prostate cancers detected by screening tend to progress slowly, and many older men die with the disease, not of it. Furthermore, all therapies for prostate cancer entail risks, and some may lead to impotence or incontinence.
This study provides additional support for the use of active surveillance of localized prostate cancer in older men, particularly among those with lower grade tumors, commented Dr. Howard Sandler of the University of Michigan at the meeting.
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