January 2012

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Delaying Treatment for Prostate Cancer

An independent panel convened by NIH recently studied strategies for managing low-risk prostate cancer that hasn’t spread. It found that close monitoring and delayed treatment may be a better option than immediate surgery or radiation therapy for many patients.

Prostate cancer is the buildup of abnormal cells in the prostate, a male gland below the bladder and in front of the rectum. It usually occurs in older men, affecting about 30% to 40% of men over age 50.

More than half of prostate cancers are confined to the prostate and unlikely to become life-threatening. But about 90% of patients receive immediate treatment, such as surgery or radiation therapy. These treatments can have serious short- and long-term side effects for many patients—including problems with sexual function and loss of urinary control—without improving survival.

“It’s clear that many men would benefit from delaying treatment,” says panel chairperson Dr. Patricia A. Ganz of the University of California, Los Angeles. “I think the real challenge that we have is that the word ‘cancer’ immediately elicits the equation with death.”

There are 2 alternatives to immediate treatment. “Watchful waiting” involves avoiding treatment unless symptoms develop. “Active surveillance” also involves delaying treatment, but includes periodic testing to detect cancer progression. More work needs to be done to know who would benefit from which approach.

Ganz added that after a review of the research, “we feel confident that in the very low-risk patients [active surveillance] is a reasonable thing to offer men when they are being told that they have this diagnosis.”