Treating prostate cancer, Part III: Active surveillance
Although cancer remains the second leading cause of death in the United States, doctors have made steady progress in controlling the dreaded disease. Many experts believe that we are on the verge of dramatic improvements based on blockbuster research that is deciphering the basic biology and genetics of malignancy. Even without these insights, early diagnosis and aggressive therapy have produced enormous gains.
The well-known benefit of "catching it early" is responsible for the enthusiastic embrace of screening tests that detect cancers before they cause symptoms. In most cases, it's a great thing, but prostate cancer may be an exception. The limitations of the prostate-specific antigen (PSA) test and the variable behavior of prostate cancers mean that randomized clinical trials are needed to tell if PSA screening is beneficial and which men are most likely to gain from it.
The benefits of "getting it all out" and "hitting it hard" explain why most patients who are diagnosed with cancer press for prompt and aggressive treatment. But here, too, prostate cancer may be an exception. Researchers have already learned that there is no need to rush into treatment. Because most prostate cancers grow slowly, men can delay treatment for many months without harm. But postponing treatment for months is one thing, deferring it for years, quite another. Is there ever an advantage to deferring treatment for prostate cancer?