Study confirms effectiveness of 'watch and wait' strategy 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 ten years shows that for most, this 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 from their disease," reports the team led by Lisa Newcome. Cancer prevention researcher at Fred Hutchinson Cancer Center in Seattle.

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

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

Several decades ago, many—if not most—men with newly diagnosed prostate cancer were quickly given treatment, usually either surgery (prostatectomy) or hormone suppressive 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.

Over the past two decades, however, new evidence about the diverse nature of prostate tumors has changed all that.

Based on certain tests, doctors can now identify aggressive, fast-growing tumors that may pose an immediate threat, as opposed to so-called “indolent” tumors, which progress very slowly.

In cases involving older men, especially, indolent tumors may not pose as serious a health threat as other diseases such as heart disease.

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

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

But how well does this strategy work to ensure that men live long and quality lives?

For their study, Newcomb's team looked at the latest data from a study begun in 2008 to track outcomes of prostate cancer treatments.

The study included 2,155 men “with good prostate cancer and no previous treatment” who were treated at one of 10 centers across North America.

The men's health was monitored for up to 10 years (average follow-up time was 7.2 years). Their average age at the time of data collection was 63 years, and 83% were white. Almost all (90%) were diagnosed with less serious grade 1 prostate cancer at study entry.

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% experienced tumor recurrence.

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

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

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