Study confirms effectiveness of 'watch and wait' tactics for prostate cancer

For a large percentage of men with prostate cancer, the tumor may grow so slowly that doctors recommend a "watch and wait" approach instead of active treatment.

Now a study of nearly 2,200 patients followed for up to a decade suggests that for most, it may be a wise decision.

"In this study, 10 years after diagnosis, 49% of men had no progression or need for treatment, less than 2% developed metastatic disease, and less than 1% died of their disease," reports a team led by Lisa Newcomb, a cancer prevention researcher at the Fred Hutchinson Cancer Center in Seattle.

According to Newcomb, "Our study shows that the use of active surveillance, including regular PSA testing and prostate biopsies, is a safe and effective strategy for managing prostate cancer with a favorable prognosis."

The study results were published May 30 in the Journal of the American Medical Association (JAMA).

Decades ago, many—if not most—men with newly diagnosed prostate cancer were quickly given treatment—usually either surgery (prostatectomy) or hormone-suppressing therapy.

Both of these interventions can be accompanied by side effects such as impotence or urinary problems, which can seriously affect a man's quality of life.

However, over the past two decades, new knowledge about the diverse nature of prostate tumors has changed all this.

Using certain tests, doctors can now identify aggressive, rapidly progressing tumors that may pose an immediate threat, as opposed to so-called "slow-growing" tumors that progress very slowly.

In cases involving older men, especially, slow-growing tumors may not pose as serious a health threat as other conditions, such as heart disease.

All this has led to many patients with prostate cancer being offered what is clinically known as an "active surveillance" approach to their condition.

In this scenario, no treatment is given. Instead, patients are asked to undergo regular tests to check whether the suspected "slow-moving" tumor has progressed into something more dangerous.

But how well does this strategy work to help men live long, quality lives?

In their study, Newcomb's group examined the latest data from a study begun in 2008 to track the outcomes of prostate cancer treatments.

The study included 2,155 men "with favorable prognosis, untreated prostate cancer" who were treated at one of 10 centers across North America.

The men were followed for up to 10 years (mean follow-up time was 7.2 years). Their average age at data collection was 63 years, and 83% were white. Almost all (90%) had less serious stage 1 prostate cancer when they entered the study.

Within 10 years of diagnosis, 43% of men had a change in tumor status based on biopsy results and were referred for treatment. Among this group, 11% had a tumor recurrence.

Still, the initial "watch and wait" strategy paid off: Among the original cohort, nearly half never needed active treatment, and only a small proportion developed metastatic cancer (2%) or died from it (1%), the Seattle team concluded.

"An important finding was that adverse outcomes such as recurrence or metastasis were not worse in people treated after several years of follow-up compared with one year of follow-up, alleviating concerns about losing the window of cure," Newcomb said in a journal press release.

"We hope this study will encourage national adoption of active surveillance rather than immediate treatment for prostate cancer," she added.