Careful watching OK for some prostate cancers

Some men with prostate cancer that hasn't spread may not need to undergo treatment, as long as a watchful eye is kept on their condition. They can do as well as similar men who undergo radiation therapy, according to a new report.

"Observation is an option for men with nonaggressive prostate cancer who are older or have other medical co-morbidities," Dr. Eric M. Horwitz from the Fox Chase Cancer Center in Philadelphia, Pennsylvania, told AMN Health.

Horwitz and colleagues compared outcomes in two matched groups of men with localized prostate cancer: 69 who were just watched (because their disease was indolent, or they had other significant medical conditions, or they refused treatment), and 69 who were treated with radiation.

Survival rates after eight years were estimated to be 73 percent in the observation group and 75 percent in the radiation group, the authors report in the journal BJU International.

After eight years, 93 percent of patients who were watched showed no sign of disease spread, as did 95 percent of the radiation patients.

Four of the patients in the observation group eventually underwent radiation treatment and fared well. "The main reasons for recommending discontinuing observation in the present patients included increasing PSA values and local progression of disease, as determined by digital rectal examination," the report indicates.

Treatment options for men with low-risk prostate cancer include surgery, external radiation therapy, or permanent radioactive seed implants, Horwitz explained. "What we recommend depends on a patient's age and health."

If patients are healthy and have a life expectancy greater than 10 years, "we recommend treatment," he continued. If they have other serious medical conditions or if they are elderly and have a low-risk cancer, "we sometimes recommend observation."

However, if a patient has a high-risk prostate cancer, "even if they are older or have other medical problems, we would recommend some form of treatment."

SOURCE: BJU International, July 2004.