FRIDAY, June 18 (HealthDay News) -- For patients with prostate
cancer that has a low risk of progression, active surveillance,
also known as "watchful waiting," may be a suitable treatment
option, according to a large-scale study from Sweden.
The issue of how (or whether) to treat localized prostate cancer
is controversial because, especially for older men, the tumor may
not progress far enough to cause real trouble during their
remaining expected lifespan. In those cases, deferring treatment
until there are signs of disease progression may be the better
The researchers looked at almost 6,900 patients from the
National Prostate Cancer Registry Sweden, age 70 or younger, who
had localized prostate cancer and a low or intermediate risk that
the cancer would progress. From 1997 through December 2002, over
2,000 patients were assigned to active surveillance, close to 3,400
underwent radical prostatectomy (removal of the prostate and some
surrounding tissue), and more than 1,400 received radiation
After a median follow-up of just over 8 years, the surveillance
group had a much higher death rate from causes
other than prostate cancer -- 19.2 percent, compared with 6.8
percent in the prostatectomy group and 10.9 percent in the
radiation therapy group.
This suggests that patients with a shorter life expectancy were
more often selected for active surveillance rather than surgery or
radiation therapy, the researchers said.
The patients who underwent surgery for prostate cancer had a
lower risk of dying from prostate cancer than those in the active
surveillance group. However, the difference in absolute risk of
patients dying from prostate cancer was very small -- only 1.2
percent after 10 years of follow-up.
The researchers concluded that, based on these findings, active
surveillance is the best strategy for many patients with low-risk
"With a 10-year prostate cancer-specific mortality of less than three percent for patients with low-risk prostate cancer on surveillance, this strategy appears to be suitable for many of these men," wrote Dr. Par Stattin, of Umea University, and colleagues.
The study was published online June 18 in the
Journal of the National Cancer Institute.
The U.S. Agency for Healthcare Research and Quality has more
treatment of localized prostate cancer.