CHICAGO--Until recently, physicians would have offered watchful
waiting only to a select group of older men with localized prostate
cancer. Now, because of concerns about the quality as well as
the length of life, physicians are vigorously debating whether
watchful waiting may be an option for men as young as the early
"Surveillance should be offered to all patients who are newly
diagnosed with prostate cancer because the data do not provide
a compelling argument that there is a lower age at which surveillance
is not acceptable," argued Ian M. Thompson, Jr., MD, at the
Chicago Prostate Cancer Shootout, a debate over the treatment
for localized prostate cancer sponsored by the Chicago Radiological
Society, Chicago Urological Society, and Chicago Medical Society.
Dr. Thompson, chief of the Urological Service, Brooke Army Medical
Center, Fort Sam Houston, Texas, reported that he recently had
extended the watchful waiting option to a 52-year-old man with
a small tumor and a prostate-specific antigen (PSA) value of 4.2
ng/mL because surveillance is the only form of treatment that
carries no side effects.
Even in the best of hands, Dr. Thompson pointed out, radical prostatectomy
results in impotence in at least 30% of patients. Among men who
are capable of erections before radical prostatectomy, only about
40% can achieve erection afterwards, and only 12% can accomplish
penetration. At least one study indicated that 63% of men had
a problem with incontinence after surgery, which may have affected
their quality of life.
Glenn S. Gerber, MD, assistant professor of surgery and urology,
University of Chicago Medical School, acknowledged that disease-
and metastasis-free survival at 10 years is similar regardless
of the method of treatment for men with grade 1 prostate cancer.
The data suggest that most men with mild or moderately differentiated
cancer will survive 10 years if left untreated, and that overall
survival or life expectancy of 10 years or less will not improve
with surgery or radiation, Dr. Gerber said.
However, the same study showed that after 10 years, more than
40% of patients exhibited bone metastases. "While it is certainly
true that patients who are placed on watchful waiting will avoid
the side effects of radical prostatectomy and radiotherapy, they
may suffer tremendous morbidity because of metastatic disease,"
Dr. Gerber stated.