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 50s.
"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.