Watch-and-Wait Approach to Prostate Cancer in Seniors

Men over the age of 65 who are diagnosed with localized prostate cancer and choose the conservative approach of “watchful waiting” are living longer. Opting out of undergoing more aggressive treatment is working for many.

The finding comes from new research recently published in The Journal of the American Medical Association. The study revealed that prostate cancer is being diagnosed earlier than ever before with widespread use of prostate-specific antigen (PSA) testing as part of patient screening. Patients diagnosed with early-stage prostate cancer are faring much better when they choose to initiate active surveillance, meaning to “watch and wait,” instead of undergoing treatment with surgery or radiation.

According to study author Dr. Grace L. Lu-Yao, an associate professor of medicine at the University of Medicine and Dentistry of New Jersey, “The most important message is that the long-term outcome for patients who don't have surgery or radiation is pretty good.”

Lu-Yao and her colleagues analyzed data on 14,516 men over the age of 65 who were diagnosed with prostate cancer between 1992 and 2002, and who did not opt to undergo surgery or radiation within 6 months of diagnosis. The average age of the men in the study was 78 years. The researchers followed their progress for an average of 8.3 years. The men were categorized by use of their Gleason score, which measures the extent of orderly structure lost in the prostate gland. The greater the extent of disorder in the prostate gland structure, the greater the cancer danger.

Among men having the least disordered tumors, the 10-year death rate from prostate cancer was 8.3 percent, while their death rate from all other causes was 59.8 percent. For men with tumors having moderate disorder, the 10-year prostate cancer death rate was 9.1 percent, and the death rate for all other causes was 57.2 percent. Men having the severely disordered tumors were determined to have a prostate cancer death rate of 25.6 percent, compared to 56.5 percent for all other causes.

The improvement seen in survival numbers can highly be attributed to the effectiveness of PSA screening in early diagnosis. Early detection means increased survival rates. Lu-Yao noted, “Patients now are diagnosed at a much earlier stage compared to patients 10 and 20 years ago.”

Lu-Yao pointed out that it has become evident that the “watch and wait” approach may be preferable to treatment among older men as well as younger men who suffer from life-threatening health conditions. The basis for this school of thought is that other health conditions will likely prove to be fatal before the slow-growing prostate cancer. During the study, men having early stage prostate cancer with a good to moderate prognosis were six times as likely to die of some other cause. However, Lu-Yao emphasized that for men under the age of 65, the best available data indicates that treatment is the best option for survival.

Although PSA testing has become a standard for prostate cancer screening due to its proven success in early-stage cancers detection, critics argue that the tool has led to unnecessary treatment for many men, while saving few lives. However, recent studies continue to lend support regarding the accuracy and effectiveness of PSA testing.

Additional research is currently being conducted on outcomes of watchful waiting versus treatment of prostate cancers at both American and Canadian medical centers. However, results are not expected for at least 10 years.