‘Watch and wait’ for some prostate cancers

When it comes to the management and treatment of prostate cancer, a “watch and wait” mentality may be the best option. A new study, published in the journal Cancer Research, backs the active surveillance—ongoing monitoring of the cancer—method for managing low-grade prostate tumors. According to the findings, many low-grade prostate tumors do not progress to high-risk cancer over time, and therefore, may not require initial treatment.

“When we hear the word ‘cancer,’ it’s very common to have the reaction that it needs to be removed right away,” says Dr. Timothy Roth, Urologist on the Medical Staff at Advocate Sherman Hospital in Elgin, Ill. “What we’re finding is that treatment, such as surgery or radiation, may not be the only initial option for some low-grade prostate cancers.”

Researchers collected data from two groups of men who were diagnosed with prostate cancer between 1982 and 2004. The study found that the number of patients diagnosed with late-stage prostate cancer dropped 85 percent following the introduction of widespread prostate-specific antigen (PSA) screenings. However, the percentage of men who were diagnosed with high Gleason scores (a way to assess the aggressiveness of cancer) changed minimally. These findings suggest that the aggressiveness of prostate cancer tumors do not appear to change over time.

According to Dr. Roth, active surveillance, may be the right decision for some low-grade prostate tumors. As part of active surveillance, the patient would undergo a follow-up biopsy as well as other assessments to ensure the cancer hasn’t progressed. “In certain cases, it makes sense to monitor the cancer and preserve the quality of life of the patient with the understanding that the cancer may need to be treated at some point in the future,” Dr. Roth explains.

This study follows the American Urological Association’s (AUA) recent modifications to its guidelines for prostate cancer screenings. The organization now recommends screenings for men age 55 to 69 at average risk for prostate cancer. However, the AUA does not recommend screenings for men under age 55 with average risk. “The general belief set forth by the AUA is men with lower risk of the disease can wait to be screened until their mid-50s.”

While many low-grade tumors do not progress to high-risk cancer, Dr. Roth acknowledges that this is not the case for all prostate cancers. Still, many patients can manage their prostate cancer and live a quality life through active surveillance. “I foresee a dramatic shift in the way that we screen and treat prostate cancer,” Dr. Roth says.