Rethinking Prostate Cancer in Older Men

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Because prostate cancer is generally a slow-growing cancer, some men may never need treatment. And for many older men without symptoms, watchful waiting has been recommended, because it was believed they would die from other causes before their cancer advanced.

But as men's life expectancy creeps higher and new robotic techniques improve the precision of surgery, the decision is becoming more complicated.

"Patients should understand the risks and benefits of all their treatment options -- radiation, surgery and observation," Wong noted. "If they choose observation, they should be committed to careful follow-up with their physicians."

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Watchful waiting does not mean watching someone die. Many oncologists today prefer the term "active surveillance," Trabulsi said, because it more accurately describes the diligent approach to monitoring these patients, including the use of PSA blood tests, digital rectal exams and biopsies of the prostate to detect changes in the cancer.

Still, determining the best course of treatment is difficult, because there isn't good data to help guide patients and their families on the effectiveness and harms of treatments for clinically localized prostate cancer, according to a recent literature review prepared for the federal Agency for Healthcare Research and Quality.

But oncologists hope to have better information on the benefits and risks of active surveillance, also known as "expectant management," compared with treatment, by late next year. The National Cancer Institute and the Department of Veterans Affairs are co-sponsoring a study, called the Prostate Cancer Intervention Versus Observation Trial, to compare radical prostatectomy -- which is removal of the gland -- and expectant management on patient survival and overall quality of life.

For now, Wong advises: "They [patients] should place the potential benefit of treatment found in our study in the context of the potential side effects of treating the patient's other medical problems."

More information

For more on treatments for prostate cancer, visit the National Cancer Institute.

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