Surgery or watchful waiting – how are mortality risks affected?

The authors aimed to determine long-term outcomes in prostate cancer patients following treatment with watchful waiting or prostate surgery.

In early prostate cancer, watchful waiting is a form of treatment that involves closely monitoring a patient to determine any signs of cancer progression, but does not involve active treatment. This is undertaken in order to avoid the side-effects of cancer treatment for cancer that may be growing slowly, or not be showing signs or symptoms at present. 

Prostate surgery is a form of active treatment that involves surgically removing the prostate gland, and is carried out in patients with prostate-confined cancer. It is still not clear whether watchful waiting or immediate prostate surgery has better long-term survival outcomes in prostate cancer. 

The aim of this study was to determine long-term outcomes in patients treated with watchful waiting or prostate surgery.

695 patients were used in this study with an average follow-up time of 13.4 years (the overall follow-up time was 23.2 years). Patients were divided into two groups: 348 patients who underwent watchful waiting and 347 patients who underwent prostate surgery.

By 18 years, 28.7% of the watchful waiting group and 17.7% of the surgery group died from prostate cancer. There was a 44% reduction in the risk of dying from prostate cancer following treatment with prostate surgery compared to watchful waiting.

By 18 years, 38.3% of patients from the watchful waiting group and 26.1% of patients from the surgery group had cancer that spread from the primary site (site of first tumor). There was a 43% reduction in the risk of cancer spreading following treatment with surgery compared to watchful waiting.

By 18 years, 67.4% of patients from the watchful waiting group and 42.5% of patients from the surgery group underwent additional treatment with androgen deprivation therapy (ADT – hormone treatment that targets the male sex hormones involved in prostate cancer, such as testosterone). There was a 51% reduction in the risk of undergoing ADT treatment following treatment with surgery compared to watchful waiting. At 18 years, approximately 60% of the watchful waiting group compared to 40% of the surgery group experienced cancer progression and required ADT or additional treatment such as chemotherapy or radiation.

Patients under 65 years had a 55% reduced risk of experiencing prostate cancer related death and a 62% reduced risk of experiencing cancer spread after surgery compared to watchful waiting. 

The authors concluded that there was a substantial reduction in mortality in patients who received prostate surgery. However, the authors also concluded that a large proportion of patients who underwent watchful waiting have not required further treatment. 

Due to the small number of patients used in this study results cannot be widely applied. 

If you are considering watchful waiting or surgery as a treatment option please consult potential risk and benefits with your doctor.