Prostate cancer is the most common cancer in American men other than skin cancer, according to the American Cancer Society, but the 15-year survival rate for prostate cancer is an impressive 94 percent.
As a result, many doctors have concluded it's better to leave the prostate cancer alone and only act if it accelerates. This is referred to as Active surveillance.
Active surveillance -- also known as "watchful waiting"
-- is a pragmatic treatment strategy derived from two known facts about
prostate cancer.
- First, prostate cancer grows so slowly in most men that they are likely to die from other causes.
- Second, the surgery and radiation therapy used to treat prostate cancer often cause impotence, incontinence and other side effects that affect the man's quality of life.
A new study followed 157 men during 13 years of active surveillance.
Researchers found that after 13 years, about 28
percent of all patients required treatment because their prostate cancer
flared up. Nearly all the men were cured of their prostate cancer, with
an overall group survival rate of 94 percent.
However, another 27 percent of the men in the study
didn't bother coming back for check-ups after being placed on active
surveillance, leaving themselves potentially vulnerable to a prostate
cancer flare-up.
Researchers also found that about 19 percent of the men refused to undergo a second biopsy three months after their diagnosis, to confirm the results of their first prostate cancer biopsy.
"We don't know exactly what the reasons are,"
Hefermehl said. "It may be that once the patient was told that this
cancer is probably 'not immediately threatening,' he might downplay the
importance of another test.
"On the other hand, some men might have real
concerns about the risk of there being a more severe cancer," he said.
"Or it may be to do with the risk of incontinence or impotence after
treatment, the idea of having cancer, a sense that nothing will really
happen to them or it may be due to another reason which we just don't
know about."
The study highlights the need for doctors to impress upon prostate
cancer patients the importance of checkups, said Dr. David Samadi,
chairman of urology at Lenox Hill Hospital, in New York City.
Dropout rates are probably even worse in the United
States than in Switzerland, said Dr. Otis Brawley, chief medical officer
for the American Cancer Society.This may be because men in the United States face more difficulty
finding transportation to the doctor, may not be able to afford the
co-pays required for each visit or might lose their insurance during
active surveillance, Brawley said.
Prostate cancer patients also might put their
condition on the back burner because they are facing other, more
critical medical issues, or just don't want to hassle with invasive
probes on a regular basis, he said.
On the other hand, Brawley said, the new study
actually is a success story for active surveillance, in that
three-fourths of the men who kept their appointments never needed
treatment.
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