Prostate Cancer: Don’t Watch and Wait

by | May 3, 2023 | Prostate Cancer, Prostate Cancer, Prostate Cancer Watch and Wait

If you were told you had a ticking time bomb in your body that you could just observe and see what happens or you could remove it and go on with your life – what would you do?

Would knowing it could go off at any moment constantly keep you up at night? If you’re like most people, the answer would be: Yes. And you’d opt to not watch and wait but to remove it – freeing yourself from the constant worry.

However, a recent study published in the New England Journal of Medicine will no doubt be very confusing to men, and while it may be exactly what they want to hear, it may not be the best thing for their survival.

The researchers leading the study say long-term evidence proves that prostate cancer treatment can wait for most men. Actively monitoring localized prostate cancer is a safe alternative to immediate surgery or radiation. Of the 1,600 hundred U.K. men involved in the study they say there was no difference in prostate cancer mortality at 15 years between the groups.

The researchers said most prostate cancer grows slowly, and prostate cancer survival for all three groups was high — 97% regardless of the treatment approach. 

Prostate Cancer Treatment: Don’t Watch and Wait

“Men diagnosed with localized prostate cancer shouldn’t panic or rush treatment decisions,” said lead researcher Dr. Freddie Hamdy of the University of Oxford. 

“Instead, they should consider carefully the possible benefits and harms caused by the treatment options.”

He added, “However a small number of men with high-risk or more advanced disease do need urgent treatments.” Britain’s National Institute for Health and Care Research paid for this research.

All that said, the experts at the CyberKnife Center of Miami, are not in full agreement with the watch and wait approach. They look at the overall health and vitality of the patient. If you have multiple health risks like heart disease, diabetes, or other major health issues maybe this approach is ok. But if you are healthy and active you want to stay that way. We think of prostate cancer as a ticking time-bomb that should be treated as soon as possible.  

Men facing prostate cancer are often told they can take a wait-and-see approach to cancer treatment because it is long believed many prostate cancers are very slow growing.

But mounting research shows that at least 50-percent of prostate cancer cases that are thought to be slow growing, turn out to be aggressive and end up spreading to other parts of the body. That makes treating cancer much more difficult and greatly decreases a man’s chances of survival.

In addition, another recent study presented by the American Society of Clinical Oncology found that the majority of men with early-stage prostate cancer, about 85%, who choose active surveillance often don’t follow the recommended monitoring guidelines.

The findings were drawn from an analysis of 346 men newly diagnosed between 2011 and 2013 with low or intermediate-risk prostate cancer in North Carolina. 

Researchers analyzed how often men received biopsies and other tests according to the guidelines from the National Comprehensive Cancer Network.

“Active surveillance has rigorous guidelines — people need regular PSA tests, they need prostate exams, they need prostate biopsies so you can watch the cancer very closely, and you don’t lose the opportunity to treat the cancer when it starts to grow,” says Dr. Ronald C. Chen at the University of North Carolina’s Department of Radiation Oncology. “One of the main findings of this study is that in this population-based cohort, not in a clinical trial or purely academic setting, only 15 percent of patients in active surveillance received recommended monitoring.”

Active surveillance guidelines recommend prostate-specific antigen (PSA) tests at least every six months, digital rectal exams annually, and a repeat biopsy within 18 months of diagnosis.

In the first six months, 67 percent of patients had received a PSA test, and 70 percent received a digital rectal exam. Just 35 percent received a biopsy within the first 18 months. Across all types of tests by 24 months, only 15 percent of patients received monitoring compliant with the guidelines.

Dr. Mark Pomper, a prostate cancer expert and radiation oncologist at CyberKnife Miami says, “The message here is if you’ve been told by your doctor that it’s okay to watch and wait after a prostate cancer diagnosis, you may want to get another opinion. When prostate cancer is found early and treated the survival rates are upwards of 98-percent. Cancer doesn’t always follow an expected path so don’t wait, get it treated, get it taken care of and get on with your life instead of worrying what might or might not happen.”

About 84% of prostate cancers are in early stages when the cancer is localized in the prostate or has just spread to nearby organs. The five-year survival rate in these cases is excellent with treatment. As the cancer spreads to other parts of the body the five-year survival rate drops significantly to 31%.

Gail Suarez, MSHSA, RT (R)(T) and Vice President of Operations at CyberKnife Miami has this to say about the watching and waiting plan, “Since many men get diagnosed with prostate cancer after age 65 of course they could do watchful waiting in hopes that they die before the cancer spreads. Prostate cancer is often slow growing and the average life expectancy for men is 73, so there is a good chance they will die of something else before prostate cancer kills them. But, if they live to be 90 and haven’t done anything about their prostate cancer they will have a very painful end of life. It’s also interesting that men in this study, in the monitoring group, had regular blood tests and some still went on to have surgery or radiation. Also, they will have urinary difficulties from the cancer as it advances. None of these studies say that the cancer will not grow or spread, just that you will die before it gets too bad if you are lucky. I can’t tell you how many men I have seen with advanced prostate cancer that die a miserable death because they watched and waited instead of getting treated immediately after being diagnosed.”

Types of Wait-and-See Approaches

There are two types of wait-and-see approaches. The “watchful waiting” approach means you would not treat the cancer but instead to observe your body for symptoms like pain. And if you notice a change, then you’d tell your doctor.

“Active surveillance” means you undergo routine testing like biopsies, imaging tests, prostate-specific antigen or PSA blood tests, and digital rectal exams to track the cancer’s growth.

These either wait-and-see approach may be right for very specific types of prostate cancer patients – like those who are too old or too sick to benefit from treatment. 

However, keep in mind, invasive and repeated biopsies also come with certain risks including infection, bleeding and trouble urinating.

The American Cancer Society says a few studies compared watchful waiting with surgery for early prostate cancer. Some of those studies indicated men who had surgery lived longer. Others found equivalent survival in both groups.

When comparing active surveillance to treatment with radiation, men who opt for radiation treatment may not live longer, but the cancer may not spread, or it may stay in remission longer. That generally means those men who opt for radiation have a better overall quality of life.

And if you’re told you are in the low-risk category for the cancer spreading, according to one blog, that’s not always the case. As we said earlier in this article, some cancers that are initially said to be low risk end up being more aggressive. That means the wait-and-see approach could be dangerous in those cases.

CyberKnife Treatment for Prostate Cancer

Dr. Pomper encourages any patient thinking about a wait-and-see approach to get a second opinion, including with highly experienced CyberKnife experts like the team at CyberKnife Miami. It’s a state-of-the-art cancer treatment center that uses a noninvasive radiation treatment system called stereotactic body radiation therapy (SBRT) to kill prostate cancer. It delivers radiation directly to the prostate leaving the healthy surrounding tissue unharmed. 

CyberKnife has few side effects. Its pinpoint radiation beams hit only the prostate, so we can give a much higher dose with a lot fewer treatments, leaving healthy surrounding tissue unharmed. There’s over 20 years of published studies support,” says Dr. Pomper.

With CyberKnife, there is less risk of burning the anus or testicles. There is also a reduced risk of impotence and urinary incontinence. Sexual function remains about the same for most patients after treatment and most patients tolerate CyberKnife treatment very well, with few if any side effects and has a 98% cure rate..

Prostate Cancer Treatment Near Me

The American Cancer Society says one in nine American men will face a prostate cancer diagnosis in his lifetime. If you are diagnosed with prostate cancer, call CyberKnife Miami for a consultation or for a second opinion. 

Why take the risk and wait? We will get you treated faster, safer, and effectively.

If you would like to find out more about prostate cancer treatment with CyberKnife, call us at 305-279-2900 or go to our prostate cancer website now for more information.