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Prostate Cancer in Seniors – Watch-and Wait Approach

Prostate Cancer

Men who are over the age of 65 and diagnosed with localized prostate cancer, are living longer when they choose the conservative approach of “watchful waiting.”  Opting out of undergoing more aggressive therapy is working well for many.  This new data is from a recently published study in the Journal of the American Medical Association.  With widespread use of prostate-specific antigen (PSA) testing as part of patient screening, prostate cancer is being diagnosed earlier than ever before.

Today’s sufferers with early-stage prostate cancer are faring much better when they choose to undergo active surveillance, meaning to “watch and wait,” instead of undergoing treatment with surgery or even radiation.  “The most important message is that the long-term outcome for patients who don’t have surgery or radiation is pretty good,” according to the study author Dr. Grace L Lu-Yao, an associate professor of medicine at the University of Medicine and Dentistry of New Jersey.

Lu-Yao and her colleagues analyzed data on 14,516 men over the age of 65.  These men were diagnosed with prostate cancer between 1992 and 2002, and they chose not to undergo surgery or radiation within 6 months of their diagnosis.  The average age of the men in the study was 78 years.  Their progress was an average of 8.3 years.  They were also categorized by use of their Gleason score, which measures the extent of orderly structure lost in the prostate gland.  The more vast the extent of the disorder in the prostate gland structure, the greater the cancer danger.

The 10-year death rate from prostate cancer was 8.3 percent among men having the least disordered tumors.  But their death rate from all other causes was 59.8 percent.  Men having the severely disordered tumors were found to have a prostate cancer death rate of 25.6 percent, compared to 56.5 percent for all other causes.  Highly attributed to the effectiveness of PSA screening in early diagnosis is the improvement seen in survival numbers.  Early detection means higher survival numbers.  Early detection means higher survival rates.  Lu-Yao noted, “Patients now are diagnosed at a much earlier level compared to patients 10 and 20 years ago.”  It has become obvious that the “watch and wait” approach may be acceptable to treatment among older men as well as younger men who suffer from any life threatening health conditions.  The basis for this school of thought is that other health conditions will likely prove to be fatal before the slow-growing prostate cancer.

This study noted that men having early stage prostate cancer with a good to moderate expectation were six times as likely to die of some other cause.  However, Lu-Yao emphasized that for men under the age of 65, the best available data shows that treatment is the best option for survival.  Critics argue that the tool, PSA testing, has led to unnecessary treatment for many men, while saving few lives.

PSA testing has become the norm for prostate cancer screening due to its proven success in early stage cancers findings.  However, recent studies persist in lending support regarding the accuracy and effectiveness of PSA testing.  Additional research is currently being conducted on the effect of watchful waiting versus treatment of prostate cancers at both American and Canadian medical centers.  The results are not expected for at least 10 years.  So choosing not to have treatment does not mean you forget about it.

The researchers said it was also important to keep a close eye on patients who chose not to be treated to make sure the cancer does not suddenly become aggressive and spread.  After lung cancer, prostate cancer is the second largest cancer killer of men.  According to the Nations Cancer Institute, over 218,000 American men were diagnosed with prostate cancer and over 27,000 died from it in 2007.

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  • dana fox September 15, 2010, 6:21 pm

    i have to urinate 8 to 10 times a day 4to5 at night lost most muscle control and shinking in size i am 62 years old now this has been going on for several years what shoud i do it has ruand my sex life

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