Healthbeat Report: Surviving Prostate Cancer

April 15, 2010 (CHICAGO)

Now, there's growing concern that some men are being over-treated. More research is backing something that's known as "watchful waiting." The question is whether this is an effective approach or a risk.

"Last fall, I won the Illinois state senior open which was a little bit of a surprise," said suburban golf pro Steven Benson.

But an even bigger surprise for Benson was being diagnosed with prostate cancer about 16 months ago.

"That was a shock," said Benson.

Benson's cancer was caught at a very early stage and considered low risk. He ruled out surgery or radiation fearing possible side effects such as impotence or incontinence.

Benson's decision was not to do anything - yet. Instead, he's taking part in the active surveillance program at NorthShore University HealthSystem.

"Our hypothesis is it is perfectly safe to leave these men alone until they develop evidence of disease progression when that happens hey will be just as curable," said Dr. Charles Brendler, urologist, NorthShore Universit y HealthSystem.

Dr. Brendler is heading up a study to determine just how safe and effective this approach is. Among other things, patients will have a PSA test every three months, a physical exam every six months, and an annual biopsy using 3-D ultrasound to see if the cancer has spread.

"We get a lot more information with this so we have increased our data significantly. That should translate into better patient care," said Dr. Michael McGuire, radiologist, NorthShore University HeathSystem.

The concept is to only use treatment if there's a real threat or if the patient decides he wants to do something.

"The idea is we save many men unnecessary treatment and we don't lose any more men to prostate cancer deaths," said Dr. McGuire.

There's mounting research showing watchful waiting or active surveillance works.

Radiation, surgery, hormone therapy and more -- there's no argument that, for some men, treatment is life- saving. But there's little evidence to show which treatment is best.

And while urologists have developed a strategy to grade the cancer's aggressiveness, there's no one definitive test to tell which tumors are harmless.

"There are no guarantees with active surveillance that everything is going to be fine in the end," said Dr. Robert Nadler, urologist, Northwestern Memorial Hospital.

Dr. Robert Nadler thinks it's a viable method but worries many men who take the wait and see approach are being lulled into a false sense of security. The Northwestern surgeon also says 25 percent of those who embark on active surveillance will still end up having treatment within five years. He's worried that could be too late.

"There is a chance he could lose the window of opportunity to treat his cancer. The patient needs to understand it," said Dr. Nadler.

What most doctors do agree with is there is no one size fits all approach.

Benson felt active surveillance was his best choice.

"I only think about my prostate cancer about 4 times a year. I have absolutely no side effects because nothing was really done," said Benson.

The University of Chicago Medical Center is also involved in the study and supporters say choosing the right patient for active surveillance is key to the approach's success.

The National Comprehensive Cancer Network which is made up of 21 cancer centers from across the U.S. is now endorsing active surveillance for certain men.

Ms. Lynne Ranz
NorthShore University HealthSystem
Prostate Cancer Center

University of Chicago Med. Center

Us TOO International Prostate Cancer Education & Support Network

Early Prostate Cancer - National Cancer Institute

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