Prostate Cancer: Watch and Wait or Ignore and Wait?
NEW YORK, NY--(Marketwired - Apr 25, 2014) A long-term European study highlighted key
patient compliance issues in the prostate cancer active surveillance strategy. In lieu of proactive prostate cancer treatments such as robotic prostate surgery, hormone therapy, or radiation, some men choose to postpone treatment and monitor the progression of their disease. Researchers found that one quarter of European men who chose to "watch and wait" failed to comply with follow-up testing, a critical component to long-term success, according to experts.
David B. Samadi, MD, Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital, perceives this pitfall as a major risk factor for prostate cancer survival. "Active surveillance and watchful waiting are only viable options if patients understand the critical nature of screening compliance," said Dr. Samadi. "So many men with prostate cancer are symptom-free and without frequent exams we have no way of preventing the disease from spreading."
Active surveillance involves undergoing regularly scheduled prostate-specific antigen (PSA) blood tests, digital rectal exam (DRE) physicals, and prostate biopsies and ultrasounds. As reported at the European Association of Urology annual meeting in Stockholm, 27 percent of active surveillance study participants abandoned their screening plans over the 13-year review period. Even at just three months post-diagnosis, 19 percent of the men refused to undergo a second prostate biopsy.
While the specific reasons for non-compliance are unknown, researchers speculate that overconfidence in a low-risk diagnosis and fear of treatment side effects may play a role. Experts from the American Cancer Society predict that active surveillance dropout rates are even higher in the U.S.
"Our job as prostate cancer experts is to help men understand the risks and benefits of each treatment path," stated Dr. Samadi. "Postponing treatment may be right for some men, but if they turn their backs on active disease monitoring, they risk a missed opportunity for curative treatment in the future. There are no guarantees that prostate tumors grow slowly."
In fact, 28 percent of study participants required some type of prostate cancer treatment within the 13 years. While the group survival rate was very high -- 94 percent -- without consistent screening, those requiring treatment would not have been aware of the more timely need.
"Men who skip treatment, screening, and medical counsel could be playing a game of Russian roulette," said Dr. Samadi. "Peace of mind comes from being vigilant about your physical wellbeing. Without monitoring, there's no way to know if and when you're treatment-ready."
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