Watchful waiting for prostate cancer

For many patients, prostate cancer is a cancer that causes no significant problems in their lives.  For a disease that causes no problems, it seems sensible to pursue a course of action where no treatment is given.

This approach has been subjected to an analysis in 828 men with prostate cancer.  These patients were observed and hormonal therapy given when there was evidence of symptomatic progression of their cancer.  For those patients with well or moderately differentiated cancers, that is, cancers that appear to be least malignant under the microscope, 87% survived at 10 years.  That means that only 13% of these patients died as a result of prostate cancer.

These results appear to be of great significance for patients with prostate cancer confined to the prostate.  They suggest that there is an excellent prospect of survival without any treatment, and this is very important when one considers that the average age at diagnosis of prostate cancer is 72.  If a man of 72 has an 87% chance of surviving 10 years without any treatment of his prostate cancer, it is a chance that this patient may consider reasonable to take. However, careful follow up is mandatory and a rising PSA or other features may well cause the clinician to recommend active treatment.

Delaying active treatment for prostate cancer is a reasonable and safe option provided that the tumour is confined to the prostate gland and is of good appearance under the microscope.  It may also be a safe thing to do for patients with cancer that looks a little bit more aggressive under the microscope.

More and more patients will be faced with the dilemma of whether or not to be treated.  This is very difficult to understand, for it is hard to come to terms with the fact that a cancer is present but doesn’t need treatment.

Much prostate cancer in this form will cause no problems for the person diagnosed and living with prostate cancer, so it is not only possible to forego treatment but it can be shown not to be detrimental.

However, all patients intending to pursue a ‘watchful and waiting approach’ need to be carefully monitored by a specialist.