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'Watchful Waiting' Safe With Low-Risk Prostate Cancers

Study suggests close monitoring offers some men better quality of life

MONDAY, March 16 (HealthDay News) -- Refusing immediate treatment can be safe for men with low-risk prostate cancer if they're closely monitored, new research finds.

The multi-center study of American and Canadian patients was conducted between 1991 and 2007.

"When or if to treat men with low-risk prostate cancer has always been a challenging question that faces patients and urologists," study author Dr. Scott Eggener, an assistant professor of surgery at the University of Chicago Medial Center, said in a news release from the university. "Some men may be rushing into treatment that won't necessarily benefit them, prevent problems or prolong life. Close observation in certain patients may provide and maintain quality of life without increasing the chances of the cancer spreading."

Between 20 percent and 50 percent of American men diagnosed with prostate cancer will eventually die from a cause other than their prostate cancer, he noted. This shows that a large number of patients don't benefit from treatment for their prostate cancer.

The 262 men in this study who decided on "watchful waiting" instead of immediate treatment met the following criteria: under age 75; prostate specific antigen (PSA) below 10 ng/ml; clinical stage T1-T2a; Gleason score 6 or below; and three or fewer positive cores at diagnostic biopsy. The patients underwent a restaging biopsy and had no treatment for six months following the repeat biopsy. They then had physical exams and PSA tests every six months with biopsies recommended every one to two years.

Of the men in the study, 43 eventually decided to have treatment or had evidence of cancer progression that prompted a doctor's recommendation to begin treatment. Following radiation or surgery, all but one of those 43 patients were cured of their prostate cancer. The remaining 219 patients remained on watchful waiting without evidence of cancer progression.

"Active surveillance with delayed treatment, if necessary, for select patients appears to be safe and associated with a low risk of metastatic spread," the researchers concluded.

The study was published in the March 16 issue of Urology.

"Active surveillance is not a total disregard for patients with prostate cancer. Instead, it identifies men unlikely to be affected by their cancer and encourages frequent monitoring, and then starting therapy at a later appropriate time if needed. Cure rates appear to be identical when these men choose immediate treatment or delayed treatment when prompted by new information about their condition," Eggener said.

More information

The Prostate Cancer Foundation has more about watchful waiting.

-- Robert Preidt

SOURCE: University of Chicago Medical Center, news release, March 16, 2009

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