Watchful Waiting Works for Older Men With Prostate Cancer

Sept. 16 -- TUESDAY, Sept. 15 (HealthDay News) -- Older men diagnosed with prostate cancer who choose watchful waiting are doing better these days than in the era before screening with a test for prostate-specific antigen (PSA) became common, a new study finds.

"The most important message is that the long-term outcome for patients who don't have surgery or radiation is pretty good," said study author Dr. Grace L. Lu-Yao, an associate professor of medicine at the University of Medicine and Dentistry of New Jersey. Her report appears in the Sept. 16 issue of the Journal of the American Medical Association.

That message applies only to men over 65 when prostate cancer is diagnosed. Lu-Yao and her colleagues analyzed data on 14,516 such men whose diagnoses were made between 1992 and 2002, at an average age of 78, and who did not have surgery or radiation in the next six months. The researchers followed them for an average of 8.3 years.

The study separated men by their Gleason score, which measures the degree to which the prostate gland has lost its orderly structure. Greater disorder indicates greater danger from the cancer.

The 10-year death rate from prostate cancer was 8.3 percent for men with the least disordered tumors. Their death rate from all other causes was 59.8 percent. For men with moderately disordered tumors, the 10-year prostate cancer-specific death rate was 9.1 percent, compared to a 57.2 percent death rate from all other causes. The prostate cancer death rate for men with the most disordered tumors was 25.6 percent, compared to 56.5 percent for all other causes.

The cancer survival numbers are much better than for the pre-PSA screening era, possibly because "patients now are diagnosed at a much earlier stage compared to patients 10 and 20 years ago," Lu-Yao said. Earlier detection translates to apparent longer survival simply because the cancer has a longer time to grow.

But the information in the study shouldn't be applied to younger men, Lu-Yao stressed. The best available data indicate better survival with treatment for men under 65, she said.