Panel: 'Watchful Wait' OK For Many Prostate Cancers

A government-sponsored expert panel says most cases of early prostate cancer shouldn't be called cancer at all, because the disease progresses very slowly, if at all. The group says men with these low-risk cancers — the great majority — should be offered the choice of deferring treatment, maybe permanently, in favor of being monitored for signs that their tumor has become more aggressive.

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A federal expert panel says that most prostate cancer these days should not be called cancer at all. Most of these tumors would never threaten the lives of the men who have them. So, the panel says, most men who are diagnosed with prostate cancer should be given the choice of postponing treatment. NPR's Richard Knox has the story.

RICHARD KNOX, BYLINE: It's kind of a startling pronouncement. The most common cancer in men may, most of the time, not really be cancer.

DR. PATRICIA GANZ: Cancer equals death for most people. Everything that is labeled cancer by the medical community does not have the same meaning for the patient.

KNOX: That's Dr. Patricia Ganz of the University of California Los Angeles. She led the panel, which was convened by the National Institutes of Health. The group says that up to 70 percent of men with newly diagnosed prostate cancer have tumors that don't necessarily need immediate surgery and radiation because they're so slow-growing. That's as many as 168,000 men a year.

GANZ: We feel sufficiently confident for these very low-risk cancers that this is one that's not going to move very fast and there's no urgency to treat it with curative intent.

KNOX: And yet only one in ten of these men are currently given the choice of putting off treatment and monitoring the situation to see what happens. Ganz says it'll take time to bring around many doctors to the idea that most prostate cancers don't necessarily need to be treated.

GANZ: There obviously are financial motivations, you know, if someone's going to get paid for surgery or radiation. We also heard that wives and family members are often saying, you know, whatcha waiting for? You know, just get it cut out. You know, there's no big deal.

KNOX: The expert panel wasn't convened to save the government money. And Ganz says she went into the deliberations not thinking she would come out the way she did. But she was persuaded by the evidence. Especially by a new, still-unpublished study of 700 men who got either surgery for prostate cancer or something called watchful waiting. Dr. Timothy Wilt of the University of Minnesota led that study.

DR. TIMOTHY WILT: Our study, along with others, have demonstrated a very low risk of dying from prostate cancer over 15 years. And that surgery does not reduce that risk.

KNOX: Wilt says most men diagnosed with prostate cancer are in their 60s and beyond. So the study shows surgery isn't likely to extend their lives.

WILT: If there was any benefit, it would have to be exceedingly long distance in the future. Yet men still would have to endure the consequences of the harms associated with treatment.

KNOX: Those harms include sexual problems and difficulty controlling urinary and bowel function. He agrees that low-risk prostate tumors should be called something other than cancer. Idle tumors, perhaps.

WILT: The fact of the matter is, is that when somebody gets labeled with a diagnosis of cancer, there are all sorts of terms that are used for that - fight the battle, win the war. Military terms.

KNOX: That kind of thinking may be obsolete. But Albany urologist Barry Kogan says the argument shifts a little bit for men his age - under 60. They have a longer life expectancy.

DR. BARRY KOGAN: For me it would probably be a coin toss.

KNOX: He agrees treatment may not be necessary for older men with low-risk tumors, but when he was diagnosed a couple of years ago with a slightly higher-risk prostate cancer...

KOGAN: I did have radical surgery to treat it.

KNOX: The point is, not all prostate cancer is the same and it shouldn't be treated that way.

Richard Knox, NPR News.

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