Physicians Rarely Recommend 'Watchful Waiting' for Men with Low-Risk Prostate Cancer

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(ChemotherapyAdvisor) – Active surveillance (“watchful waiting”) can allow men with low-risk prostate cancer to remain treatment free for more than 6 years and to avoid potentially-unnecessary immediate surgery or radiation therapy, at the potential cost of 1.8 months of life expectancy, over 20 years.

But few physicians recommend active surveillance for low-risk prostate cancer, according to a new study by Mayo Clinic researchers, presented at the North Central Section of the American Urological Association's annual meeting Oct. 10 in Chicago.

Instead, the survey of 643 urologists and radiation oncologists found, 47% recommend their patients undergo surgery and 32% recommend radiation therapy, reported lead author and Mayo Clinic urologic oncologist Simon Kim, MD, MPH. Physician recommendation tended to reflect their own specialization, the team noted; urologists tended to recommend surgery while most radiation oncologists recommended radiotherapy.

"Our results may explain in part the relatively low use of active surveillance for low-risk prostate cancer in the United States," Dr. Kim said.

The optimal modality for monitoring tumor progression is not yet clear, but active surveillance in general is widely recognized as an effective strategy for managing low-risk prostate cancer. Nevertheless, only 21% of physicians who participated in the survey recommend watchful waiting, despite, Dr. Kim's team found.

Conformal and intensity-modulated radiotherapy (IMRT) are useful in moderate and advanced prostate cancer, but radiotherapy's role in treating early-stage cases is controversial, particularly for older men, who are less likely to die from their prostate cancer.

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