Life & Times Blog - Blog Archive - Prostate Cancer: Watchful Waiting Vs. Treatment

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About the Story: He didn't want the side effects of impotence and incontinence. So Eric Kaldor opted for "watchful waiting." Some doctors say aggressive surgery and radiation are not always needed to keep the cancer at bay. Sam Louie looks at the debate over the best way to treat the second most frequent form of cancer in men. (TRT: 7:40)

: The Cancer Blog; Louis Warschaw Prostate Cancer Center; MedicineWorld.org’s Prostate Cancer Blog; Medline Plus’ Prostate Cancer Website; National Cancer Institute; Prostate Cancer Foundation; Prostate Cancer Research Institute; Prostate Oncology Specialists; Prostate.com; Prostate-Help Blogs; PSA Rising’s “Pomegranate Juice Slows PSA Rise” Blog

Prostate Cancer: Watchful Waiting Vs. Treatment

Publish date: October 11, 2006
Last updated: March 20, 2008

Reporter's NOTES

Sam Louie
My story is on the debate within the medical community on which treatment method is best for prostate cancer. Apparently, many men (one study suggests over 90%) with low-grade prostate cancer are getting their prostates removed by surgery.

But because of the negative side effects associated with the more aggressive forms of treatment, some doctors are advocating a “watch & wait” approach, since many of the low-grade prostate-cancer patients will never move beyond that point. I never thought much about cancer until covering this issue.

Apparently, prostate cancer is the second leading cause of cancer among men (second only to lung cancer), so as a man, the thought of enduring either prostate cancer or its side effects (impotency or incontinence), is scary. The story also showed the bravery of patients who know that this will likely claim their lives, yet they continue to enjoy their lives as best as they can.

Insider Viewpoints

Prostate cancer is not a single disease with a uniform natural history, but a disease with a highly variable growth rate and lethal potential. This fact makes the choice of treatment difficult.

There is no one treatment that is right for all cases, but there is a correct treatment for each patient. It is our job to treat these patients to educate them about their options and help them arrive at the treatment modality that best conforms to the facts of their individual case.

Since multiple medical specialists treat this disease, it is commonly thought that each is biased to recommend the treatment they do (i.e., surgery versus radiation). Additionally, within surgery and radiation, there are multiple choices (i.e., open versus robotic prostatectomy or radioactive seeds versus external beam radiotherapy).

Since no one specialty has all the answers, seek multidisciplinary consultations. Be sure to find a physician and a facility that treats a large number of prostate-cancer patients. It has been well established that experience correlates with superior outcomes.

Stuart Holden, M.D.
Director
Louis Warschaw Prostate Cancer Center

Aggressive PSA screening and powerful new biopsy techniques are finding prostate cancer at a very early stage. Many of these early cancers will never progress or cause illness.

Often, doctors and patients proceed with treatment anyway “just to be safe.” But a study of the effectiveness of surgery published in the New England Journal of Medicine shows, at best, a five percent improvement in a 10-year survival.

Also, surgery and radiation cause loss of sexual function, loss of bladder control and loss of rectal control. Active surveillance is an alternative approach consisting of close monitoring with aggressive treatment restricted only to men that have a rising PSA or evidence of cancer progression on repeat biopsy.

A recent study published in the Journal of Oncology indicates that only 15% of men embarking on active surveillance will need aggressive treatment within the ensuing eight years. The reported a mortality rate using this approach was less than one percent.

Dr. Mark Scholz
Medical Director
Prostate Oncology Specialists

COMMUNITY VIEWPOINTS

02.22.2007 | 9:13 am
I found this page with all the latest news about prostate cancer. It has a lot of links to the reliable sources, like NIH, CNN, WebMD and the L.A. Times: prostate cancer news I hope it’s helpful.

Erin Lee - B. Hills, California

10.20.2006 | 6:22 pm
Hello Helen,

Unfortunately, we at Life & Times are unable to give you expert advice about your husband’s cancer. However, you can click on any of the websites we’ve provided under the “Related Resources and Links” section on this page.

These pages might be able to provide you with answers. If you still can’t find the answer to your question, most of these websites and blogs usually have an easily accessible contact information page where you can either call them or e-mail them. I hope you find what you’re looking for. Good luck and thank you for commenting on our blog.

KCET Admin - Los Angeles, California

10.20.2006 | 1:09 am
My husband was diagnosed with cancer about a year ago with a Gleason score of nine. Apparently, it is terminal and inoperable and he is having zumeta infusions monthly and lucrin injections three monthly.

Apparently, chemotherapy or radiotherapy is not contra indicated. He has a secondary in his sternum, which at the moment, is not causing any trouble.

Just wondering what to do next. He also takes naturapathic therapy.

He sleeps almost all day and has no energy. Is this because of the cancer? Please, can you respond with some kind of answer?

Helen Wggins - Perth WA 6059,

10.12.2006 | 7:46 pm
Hi Roy,

Thank you for your interest in Life & Times! You can e-mail the Life & Times team at lifeandtimes@kcet.org.

KCET Admin - Los Angeles, California

10.12.2006 | 5:25 pm
I would like some information on Life & Times. Can I e-mail Val Zavala?

Roy Bufanda - South Gate, California

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