'Watchful Waiting' Safe With Low-Risk Prostate Cancers

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This is an interesting demonstration of what is called in statistics a type I error. That is, to reject a null hypothesis when in reality the null hypothesis is true. In this case the null hypothesis would be “watchful waiting has the same mortality as surgery”. A similar study (J Natl Cancer Inst. 2008 Aug 20;100(16):1144-54) accepted the risk of a type I error as 5% after enrolling 233 patients for each group (466 total). However the overall event rate was lower than anticipated and therefore, the Steering Committee decided to increase the target to 700 patients. The study described herein studied 266 patients and therefore it is underpowered and has a classic type I error. Hence, the comments from the other readers stand and the authors should retract this paper.

Diether of NY 11:01AM March 22, 2009

I saw a tall slender man wearing an expensive suit and tie sitting in the fist clas section, talking loudly on his cell phone to his "agent", signing autographs for googlie-eyed passengers, and I knew immediately-- he must be someone impotent.

The Minister, Your Mom, and the Maker of TX 9:22PM March 17, 2009

There is still a high rate of impotency and incontinence even with the robotic technique. And although there are many men with prostate cancer few die of the disease -- by age ninety prostate cancer incidence is almost 100%. If we could figure out which men are most likely to develop advanced disease many men could be spared treatment which could be of no benefit with considerable side effects. We need more research and insight into what separates a "benign" cancer from one that can kill.

Bill of FL 10:51AM March 17, 2009

This article and the study underlying it are pushing a passive approach to a serious male cancer. Why is this in a nation that is perennially "at war" with cancer as evidenced by all the pink ribbons and other ribbons, wrist bands, etc that are used to "raise awareness"? The fundamental thinking is that prostate cancer occurs largely in older males and the cost of treatment is larger than the value of older men now that they are retired. These studies are designed to give a "scientific basis" that insurers and Medicare can sieze upon to restrict and limit treatment. The hope is that these men will die of other causes before prostate cancer metastasizes. What is being said, unwittingly, is that older, sick men are expendable because they aren't cost effective. This is the next step down the path to euthanasia.

MrEDog of MI 8:05AM March 17, 2009

At prostate biopsy, my cancer was staged as T1C. After surgery, it was determined to be a T2C. Gleason scores and staging are often upgraded upon post-surgical pathology, sometimes revealing cancers that are more aggressive and advanced than estimated at the initial prostate biopsy, which is derived from sampled shavings of the reachable prostate.

Michael L of NY 5:58AM March 17, 2009

When I was referred for prostate biopsy, my PSA was 4.9, up from 3.5 last year. The biopsy disclosed 3 positive cores out of 12 and my Gleason score at that time was 6. I had normal digital rectal exams. If I had followed this article's advice, I would NOT have had a robotic prostatectomy and the benefit of a post-operation pathology report. I would NOT have known that my Gleason score was really a 7, I would NOT have known that 30 percent of my prostate was cancerous, I would NOT have known that my cancer was really a Stage T2C and I would NOT have known that most of the cancer was in the posterior of the prostate, which was unreachable during digital examination and prostate biopsy. I also would NOT have known that the cancer was close to spreading outside the prostate. I am convinced that naturopaths are naive, sublimely ignorant of medical realities and often offer irresponsible "advice." If I had "watchfully waited" as per this article, I'd be undergoing radiation treatments and/or last-ditch hormone blockade therapies in five years. I am glad I had the radical robotic prostatectomy. My cancer is gone. My PSA is now undetectable, i.e. perfect. US News & World Reports owes the public a retraction and a more thoughtful article. This is not journalism, it is simplistically ignorant and a dangerous over-generalization of a very serious condition.

Michael L of NY 5:02AM March 17, 2009

When I was referred for prostate biopsy, my PSA was 4.9, up from 3.5 last year. The biopsy disclosed 3 positive cores out of 12 and my Gleason score at that time was 6. I had normal digital rectal exams. If I had followed this article's advice, I would NOT have had a robotic prostatectomy and the benefit of a post-operation pathology report. I would NOT have known that my Gleason score was really a 7, I would NOT have known that 30 percent of my prostate was cancerous, I would NOT have known that my cancer was really a Stage T2C and I would NOT have known that most of the cancer was in the posterior of the prostate, which was unreachable during digital examination and prostate biopsy. I also would NOT have known that the cancer was close to spreading outside the prostate. I am convinced that naturopaths are naive, sublimely ignorant of medical realities and often offer irresponsible "advice." If I had "watchfully waited" as per this article, I'd be undergoing radiation treatments and/or last-ditch hormone blockade therapies in five years. I am glad I had the radical robotic prostatectomy. My cancer is gone. My PSA is now undetectable, i.e. perfect. US News & World Reports owes the public a retraction and a more thoughtful article. This is not journalism, it is simplistically ignorant and a dangerous over-generalization of a very serious condition.

Michael L of NY 4:55AM March 17, 2009

Another article had the following:
"ACS statistics show that although about one in 6 men will be diagnosed with the disease during their lifetime, only one in 35 will actually die from the cancer."
I'm not sure how to reconcile the following with the above:
"Between 20 percent and 50 percent of American men diagnosed with prostate cancer will eventually die from a cause other than their prostate cancer, he noted."

Paul Smith of CA 11:25PM March 16, 2009

Isn't it frustrating when you're told "sorry we can't help you" - just wait until you get more signs and symptoms that are likely to kill you. Then we'll do surgery.
How does waiting give you any peace of mind. Or sense of control over your life and your health status? You want to take action - preferably now!
Hello, I'm Carol Bannister, a Naturopath & Medical Herbalist in Rotorua New Zealand. I am interested in promoting wellness - long before illness strikes. And if illness does strike, then I have a whole arsenal of natural medicines that always amaze me just how well they work to turn around my clients' health and wellbeing. Certainly with prostate enlargement, I have had clients whose PSA has returned to within normal range with a course of supervised herbal medcine and health and wellness changes.
So don't give up guys! As Linda says - get yourself an appontment with a reputable natruopath and see how things can improve.

Carol Bannister 8:00PM March 16, 2009

I note that biopsies are recommended "every one or two years:. I had brachytherapy (seed implants) five years ago and, apart from the fact that I spent a day and a half at the hospital--end of story. I do have blood tests annually (for PSA, lipids and god knows what all), but I do NOT have to have painful biopsies (and they ARE painful) and the rest of my life has not been altered by worrying about things to come. At my age (67) I may still die of cancer, or a heart attack, or by getting hit by a truck or shot by Dick Cheney. But I have suffered absolutely NO side effects from the seed implant and I am not concerned about future pain ,expense or problems from biopsies. More importantly, I am not concerned about having failed to do something when I could have. If the treatment had been Draconian, or if there had been predictable and seveer side effects, I might have "waited and watched', but I didn't and I'm glad that I didn't.

Joe of IA 6:55PM March 16, 2009