Some Prostate Cancers Don’t Need Treatment

Because prostate cancer has several different types of treatment (surgery, radiation, hormone therapy) a patient may find himself in some confusion about his care. This can become even more uncertain when the possibility of ‘watchful waiting’, i.e. no treatment, is included in the options.

A review of data from 13 major registries encompassed over 70,000 men with localized or regional prostate cancer from 2000 through 2002. The University of Michigan scientists then narrowed their study to include 25,000 of them whose age at diagnosis, or the stage at diagnosis, or both, gave them a low 20-year risk of dying from prostate cancer. Based on these criteria, a watchful waiting approach (regular monitoring of PSA levels) could have been advised for these 25,000 men.

In fact, just over half these low-risk men had ‘curative’ treatment - prostatectomy in roughly 2,500 and radiotherapy in 11,000 of them. The scientists consider that these 13,500 men were overtreated. Watchful waiting would have been quite suitable for them.

This is a somewhat controversial point of view, and will certainly be discussed among the experts. It must be remembered that watchful waiting includes hormone therapy in some men, so that it isn’t totally without side effects. But it is clearly much less invasive than surgery or radiation, and seems to be a fair option for low-risk patients. One certainly doesn’t want the cure to be worse than the disease.