‘Watchful Waiting’ Becoming More Common for Prostate Cancer Patients

Recent advances have made PSA screening for prostate cancer more effective – so much so that current federal guidelines that now recommend against routine screening for men should be updated, a top doctor argues. The study included men with tumors classified as stage cT3aNoMo or lower managed with prostatectomy, radiation, androgen deprivation monotherapy, or active surveillance/watchful waiting between 1990 and 2013. It is generally reserved for avoiding treatment altogether for older, sicker patients who will most likely die from something else. He added, “Using strict inclusion criteria for very low-risk or low-risk prostates cancer can select a group of prostate cancer patients for active surveillance who would avoid the side effects of therapy while experiencing comparable survival and quality of life”.

One in seven men will be diagnosed with prostate cancer during his lifetime, according to the American Cancer Society.

Last week, a study in the journal JAMA Internal Medicine suggested that the wide majority of men with low-risk prostate cancer between 2010 and 2011 had treatment.

“This is progress in the right direction”, said lead author Dr. Matthew Cooperberg of the University of California, San Francisco.

The ideal rate of active surveillance for low-grade disease isn’t clear, Cooperberg told Reuters Health, but “it’s probably higher than 40 percent”. Among low-risk men aged 75 and older, the rate of watchful waiting shot up from 22 percent in 2000-2004 to 76 percent in 2010-2013, the study found. Conversely, treatment with androgen deprivation for intermediate-risk and high-risk tumors, which had been increasing steadily from 1990 (10 percent and 30 percent, respectively), decreased sharply (to 4 percent and 24 percent, respectively).

As for patients at greater danger, “we’re seeing more aggressive management of higher- risk disease with surgery, radiation or both, which is also a trend toward better management”, Cooperberg said.

The latest research on prostate cancer has helped make screening more individualized than the ex- one-size-fits-all measurement of the level of prostate-specific antigen in a man’s blood of the past. The researchers hope the decline in use of aggressive treatments – as inferred from the increase in surveillance – will lead to a re-evaluation of the risks of PSA testing.

Currently, the government-backed US Preventive Services Task Force (USPSTF) recommends against screening for PSA levels.

The American Urological Association recommends against PSA screening in men younger than 40.

Studies have shown that 10 to 14 years after screening very few lives are saved even among men under 70. It recommends that men ages 55 to 69 decide about PSA testing after discussions with their doctors.