Prostate cancer is the most commonly diagnosed cancer in men in Australia. It’s estimated that more than 16,000 new cases of prostate cancer will be diagnosed in Australia this year. There are various approaches to treating prostate cancer that depend largely on the individual involved and how advanced the cancer is at the time of diagnosis. Options include surgery, radiation therapy, active surveillance and watchful waiting. There is some confusion as to whether watching and waiting is a viable approach and how it fares compared to surgery. The evidence reporting outcomes associated with each approach is mixed and varies depending on the individual’s circumstances.

A recently published study reported health outcomes and death in men with prostate cancer over close to two decades of follow up including treatments they received. Men with localised prostate cancer who received either radical prostatectomy or observation were analysed. At baseline, for inclusion in the study, they had to have a PSA value of less than 50 ng/mL, be younger than 75 years and have a life expectancy of at least 10 years. Data were collected on disease progression, treatment received and outcomes reported by the patient. All cause death rates and death due to prostate cancer was recorded.

During the 20 year follow up, in men with localised prostate cancer, radical prostatectomy was not associated with significantly lower all cause or prostate cancer caused death than observation. Death due to prostate cancer was uncommon among men with low-risk disease who undertook observation however surgery may have been associated with lower deaths in men with intermediate disease risk.

Implications

This research is not intended to advise people to take one course of action over another. It rather shows that there are various approaches to treatment that can be taken – some involving action and others involving watching, waiting and reassessing over time. There is no one size fits all solution so it’s important that you have all the information and make a decision that is going to best suit your circumstances. Have a conversation with your doctor about what your level of risk is, what all of your treatment options are, the potential outcomes of each option and the likelihood of each outcome occurring.  

 

Last Reviewed: 06/02/2019

© Norman Swan Medical Communications.



References

Wilt, T et al. (2017). Follow-up of Prostatectomy versus Observation for Early Prostate Cancer. N Engl J Med; 377: 132 – 42. DOI: 10.1056/NEJMoa1615869.