"Watchful waiting" OK for some prostate cancers

New research shows that it's possible to identify men with slowly progressive or latent prostate cancer, reflected by prostate specific antigen (PSA) levels that remain stable or fall over time.

These men are good candidates for a "watchful waiting" approach to managing their cancer, study investigators suggest. In other words, such patients can be monitored regularly and only treated if their cancer progresses.

"Watchful waiting remains a controversial prostate cancer treatment strategy," Dr. Stijn H. De Vries and colleagues from Erasmus Medical Center in Rotterdam, the Netherlands, acknowledge in their report in the Journal of Urology.

They evaluated tumor characteristics at diagnosis and changes in PSA with time in 191 men with prostate cancer detected via screening. All the men were initially managed with watchful waiting based on the advice of their doctor or their own preference.

Of the 191 men, 161 had "favorable" tumor characteristics and a PSA less than 10.

During an average follow-up of 40 months, PSA levels declined for 35 men. In 85 men with increasing PSA levels, the average PSA doubling time - a measure of tumor activity - was nearly 10 years.

During follow-up, a total of 30 men underwent treatment including radiation therapy and surgical removal of the prostate. For 25 of these men, signs of cancer progression triggered a recommendation for treatment, but five men decided to go ahead even though their cancer appeared stable.

Six men died during follow-up, none of prostate cancer.

This study shows that in carefully selected men with screening-detected prostate cancer "it appears safe to delay curative treatment or even refrain from treatment," the team concludes.

They emphasize, however, that further follow-up is needed to validate these results.

SOURCE: Journal of Urology, December 2004.