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Watchful waiting is sometimes the best option

Published on October 21, 2016 at 14:43 / Updated on May 3, 2021 at 20:10

Prostate cancer is the most commonly diagnosed cancer among men in Canada. It is estimated that one out of every seven men will be diagnosed with it at some point in his life and that one out of 27 will die from it. As of age 50, physicians usually suggest screening for this cancer through a digital rectal exam and a blood test (called PSA), two exams that provide complementary information.

However, most prostate tumours progress very slowly and do not put men’s lives in danger. Consequently, when localized prostate cancer is diagnosed, doctors and patients must make a difficult decision: surgically remove the tumour and/or undergo radiation treatments, or take a more conservative approach of monitoring the evolution of the tumour without doing anything else. The problem is that the treatments for prostate cancer are often associated with adverse effects such as urinary incontinence and erectile dysfunction. A new study – the largest on this topic to date – was conducted to answer the question: Should we treat or just wait?

From 1994 to 2002, 731 men with localized prostate cancer were randomly assigned to either a radical prostatectomy (removal of the tumour) or watchful waiting. After an average follow-up of 10 years, 47 percent of the men assigned to the radical prostatectomy had died, compared to 49.9 percent of the men assigned to watchful waiting. Causes of death varied: among the men who underwent the surgery, 5.8 percent died of prostate cancer or as a result of its treatment, compared to 8.4 percent of the men who were simply being monitored. The difference in the two groups was not statistically significant. In addition, more than one out of five patients who underwent a radical prostatectomy experienced adverse effects in the 30 days following the procedure, including one death.

Not all prostate cancers are the same. Some are very aggressive and require the appropriate treatment. However, for the more indolent forms of the disease, this study shows that an invasive treatment may do more harm than good. If you are diagnosed with prostate cancer, don’t hesitate to discuss the matter with your physician and to ask questions so that you fully understand what is involved in the treatment and can make an informed decision.

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