Watchful Waiting for Older Men With Prostate Cancer

Men over age 65 who are diagnosed with low-risk prostate cancer and choose “watchful waiting” rather than aggressive treatment will most likely not die of the cancer, according to a new study.

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Older men diagnosed with prostate cancer who have small, low-risk tumors—defined by PSA level and Gleason score (See Tell Me More at left)—may want to choose a conservative approach known as “watchful waiting” instead of more aggressive treatments. A recent study, the largest of its kind, reports that survival rates have improved to 94 percent in such cases, even without surgery or radiation treatment.

This leaves little room for improving survival outcomes with treatment, says the study’s lead researcher, cancer epidemiologist Grace Lu-Yao. Yet only 10 percent of men age 60 or older choose watchful waiting.

Lu-Yao and her colleagues at the Cancer Institute of New Jersey in New Brunswick studied data on more than 14,500 men 65 years old and older whose cancer had not spread beyond the prostate and who had opted for watchful waiting. For the majority of men, the risk of dying from prostate cancer was less than 10 percent over 10 years. Study subjects ages 66 to 74 who opted for watchful waiting had a 6 percent chance of dying from the cancer.

People usually think that all cancers are life-threatening, says Lu-Yao. “But prostate cancer is different,” she says. “About 20 percent of the men in the study have high-risk cancers and need treatment, but for the majority of men a low-risk cancer is more like a chronic disease than an acute one.” In her study, most men diagnosed with low-risk prostate cancer were either alive after 10 years or had died of other causes.

“Although we still call it watchful waiting, what we’re really talking about is active surveillance,” says Martin Sanda, M.D., director of the Prostate Cancer Center at Beth Israel Deaconess Medical Center in Boston, who was not involved in the research. He says that this approach involves regular tests, rectal exams and ultrasound imaging.

Lu-Yao stresses that research shows men who have elevated PSA levels and Gleason scores or whose cancer has spread benefit from treatment. And, she says, the results of this study do not apply to men younger than 65. “There’s a study now in progress for younger men but the results won’t be in for another 10 years.”

The study appeared in the Sept. 16 issue of the Journal of the American Medical Association.

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Nissa Simon, a health writer, lives in New Haven, Conn.