IF MEN HAVE PROSTATE CANCER: CONFLICTING REPORTS ABOUT WHAT TO DO

Watchful waiting is certainly not a new approach. It’s been a mainstay of prostate cancer treatment for years; and today, one third of men with prostate cancer are treated with watchful waiting.

Some doctors who argue for watchful waiting refer to studies that suggest the mortality rate for men who don’t get treatment is low—about the same as for men who don’t have prostate cancer.

But results can be seriously misleading. One prominent Swedish study, for example, citing a “high ten-year survival rate in patients with early, untreated prostatic cancer” has been widely criticized because it’s based on a group of older men, average age 72, with small, slow-growing tumors. (Only 4 percent of these men had aggressive, poorly differentiated tumors—unlike the 10 percent to 20 percent of men with localized cancer in this country who undergo therapy. So basically, this was not a typical group—many of these patients would have been followed with watchful waiting in the United States, as well.)

After ten years, 13 percent of these men had died from the cancer. And the disease had progressed in another so percent of the men. Most of these men eventually did need treatment (castration or hormonal therapy) to treat urinary obstruction, bleeding or pain.

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