When most doctors discover a cancerous lump of some sort, they usually suggest an aggressive treatment to rid the patient of the tumor as quickly as possible. Usually an “aggressive treatment” means a removal of the cancerous growth and sometimes radiation therapy if the tumor is especially dangerous. The theory behind the more proactive approaches of removal and radiation therapy is that cancerous tumors grow quickly and can eventually kill a person if left untreated. However, new research on prostate cancer seems to suggest otherwise—at least for lower-risk tumors.
According to a recent study by Dr. Martin Sanda, director of the Prostate Cancer Center at Beth Israel Deaconess Medical Center, in men with low-risk types of tumors there was no significant difference between those who sought immediate treatment versus those who opted for the “watchful waiting” approach. Specifically, Sanda and his colleagues looked at 51,000 men nationwide diagnosed with prostate cancer. Over a 15-20 year time period, the researchers found that about 10% of the men chose the “watchful wait” approach, or delaying any treatment for at least a year or more. At 10-15 years later, the men who chose this approach still required no treatment, revealing the fact that some tumors don’t require immediate treatment because they are of a slower-growing variety.
For years, doctors have relied on a test called the PSA blood test that indicates whether a male patient has prostate cancer. Primarily, all men over 50 are instructed to have a prostate exam and the PSA blood test. However, Dr. Sanda believes that the test is a “double-edged sword”: while the test can catch serious tumors in a few, it can also cause needless worry and expense for the majority of men with tumors that grow too slowly to cause any real harm. Furthermore, according to Dr. H. Gilbert Welch of the VA Outcomes Group, an estimated 1.3 million additional men have been diagnosed with prostate cancer since the PSA test was first introduced in 1986. Of those 1.3 million, 1 million underwent surgery and other aggressive treatments. Granted, prostate cancer deaths have decreased since the introduction of PSA testing, however, Welch states that about 20 men had to be diagnosed and unnecessarily treated for every one man who actually benefited from an aggressive treatment approach.
Aggressive treatments include surgery, radiation, and/or hormone therapy and can result in impotence and incontinence in about a third of patients. Moreover, simply telling a patient that they have cancer can do harm—resulting in anxiety and feelings of vulnerability. Worst of all, having a cancer diagnosis can mean some men can’t get health insurance coverage. Currently, I have the “low-risk” cancer and have surgery scheduled in a month. But, after reading the results of this study, I am now seriously considering the “watchful waiting” approach.
