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Page 1 of 2  So you’ve been diagnosed with prostate cancer and you’re doing your homework, poring over the treatment options. You read about surgery, external radiation, radiation seeds that are implanted in the prostate, hormonal therapy, and a procedure that freezes your prostate.
And then you stumble across something called “watchful waiting.” That means you and your doctor do nothing about the cancer – for now. Only until tests show your cancer has taken off like a runaway locomotive do you undergo treatment.
Unfortunately, urologists say that watchful waiting is not a viable option for men in their 40s, 50s, and 60s, for obvious reasons of life expectancy. But men in their 70s with early-stage prostate cancer are not taking a big risk with their lives by going with watchful waiting, cancer experts at the Robert Wood Johnson Medical School in New Jersey suggest.
In one of the largest studies on watchful waiting since the PSA blood test became available in the 1980s, only 10 percent of the 9,000 men in the project who chose watchful watching died of the disease a year later. The rest lived without significantly worsening symptoms or had died of other causes. Even the 30 percent of the elderly men who eventually sought treatment delayed it for about 11 years. How quickly will it grow?
Why is this the case? While one of the most common forms of cancer in men, most prostate tumors grow very slowly. However, doctors so far can’t tell which ones will grow like tortoises or speeding locomotives, but the fact that prostate cancer is so slow growing has left many physicians—and patients—wondering whether they are “overtreating” the condition.
What’s more, for much older men, surgery and radiation are pretty tough on older men. Even younger men face sexual and urinary problems after undergoing surgery or radiation. So doctors often recommend that men in their 70s and older engage in “watchful waiting,” although studies smaller than the most recent one are conflicted about the safety of such measures.
Dr. Grace Lu-Yao, a researcher at Robert Wood Johnson Medical School, led the project that looked at how prostate cancer progresses in more than 9,000 men who chose watchful waiting. Half of the men in the study were over 75 and had tumors picked up through PSA tests.
Ten years later, only 3 to 7 percent with low- or moderate-aggressive tumors died of the disease, compared to 23 percent of those with highly aggressive cancers. Overall, prostate cancer killed 10 percent, according to the findings. 'Die of something else?'
"The great majority of patients are going to die of something else, so most older men with early-stage tumors could delay treatment,” Lu-Yao says. "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, she warned, "if people are younger or have more advanced disease, I wouldn't say this is a safe option."
Lu-Yao and other cancer experts say more study comparing all treatment options is needed before “watchful waiting” becomes a standard recommendation for older men. For instance, an article in a recent Annals of Internal Medicine said evidence was pretty thin on recommending treatment over watchful waiting or one treatment versus another, but other studies show that surgery helps mostly men under 65, like me.
Regardless of the findings, some experts caution that very active, healthy older men and men with highly aggressive tumors should forgo watchful waiting in favor of surgery, radiation or other treatments.
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