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NEJM Study Boosts Argument for Watchful Waiting Approach to Prostate Cancer

Surgery did not improve mortality outcomes in patients with localized disease

The watchful waiting movement in prostate cancer has been bolstered by a study that compares men who choose that path with men who have surgery immediately. Researchers at Washington University in St. Louis tracked 731 men over a 20-year period, from November 1994 through August 2014. Their findings, published in the New England Journal of Medicine, said that for “men with localized prostate cancer, surgery was not associated with significantly lower all-cause or prostate-cancer mortality than observation.”

In fact the study, which was sponsored by the Department of Veterans Affairs, says that surgery “was associated with a higher frequency of adverse events than observation but a lower frequency of treatment for disease progression, mostly for asymptomatic, local, or biochemical progression.”

Watchful waiting reduces the side effects of surgery or radiation or hormone treatment, which can include incontinence, impotence, and infection. Scientists have for some time underscored that prostate cancer treatment can cause more harm than the disease ever would.

David Penson, MD, Vanderbilt University’s urology chief, told the Associated Press: “You can’t divorce quality of life outcomes from cancer outcomes because they both count for patients. Some guys will look at this and say, ‘I don’t want to be impotent, I don’t want to be incontinent,’” said Dr. Penson, who played no part in the study. “They’ll opt against surgery even if there’s the chance that it will make them live longer. In the end, each man’s going to make his own decision.”

Source: New England Journal of Medicine; July 13, 2017.

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