“Watchful Waiting” Yields Outcomes Equal to Surgery for Early Stage Prostate Cancer

Unnecessary and/or overaggressive treatment is one of the great weaknesses of the healing arts. Prostate cancer treatment is one of the current flashpoints, because most prostate cancers are slow to grow and begin when the men are old enough that they will eventually die “with prostate cancer” rather than “of prostate cancer.”

This article from the New York Times Well Blog sums it up well:

This year, about 240,000 men will be given a diagnosis of prostate cancer. Although 81 percent of them will discover the disease at a very early stage, and although prostate cancer usually grows very slowly, most of these men will choose aggressive treatment, opting for removal of the prostate, or radiation treatments that often render them impotent or incontinent — or both.

But about 10 percent of men choose a different strategy: no treatment at all. The decision to forgo surgery or radiation is controversial, and is often met with resistance from a man’s own doctors and family members.

The strategy is often called “watchful waiting,” but some experts term it “active surveillance” or “expectant management.” In older men, watchful waiting may mean that nothing at all is done; doctors intervene only for pain relief or minor procedures if there are signs the cancer has spread.

In younger men, doctors typically conduct regular blood tests and biopsies to monitor the cancer. The idea is that they may recommend surgery or treatment later if it appears the cancer is aggressive and beginning to spread.

Few men choose watchful waiting and few doctors recommend it, but that may soon change. Last week, a groundbreaking new study showed that men with early-stage disease who opt for watchful waiting are just as likely to survive as men who undergo surgery.

The findings, published in The New England Journal of Medicine, come from a 15-year study of 731 men with early-stage prostate cancer who, surprisingly, had agreed to be randomly assigned to surgery or a program of watchful waiting. The fact that so many men had agreed to leave their treatment to chance is remarkable in itself. But so were the findings.

During the study, the largest of its kind, 52 men, or about 7 percent of the study subjects, died of prostate cancer. There was no statistical difference in the prostate cancer mortality rate or the overall death rate between the groups. Most men survived the disease whether they had surgery or did nothing.

And some men who had surgery died, as did some men who did nothing.