Watchful waiting after PSA tests? No worries

Patients managed conservatively don't appear any more anxious or depressed.

Concerns that men whose prostate cancer is treated conservatively may be left anxious and depressed have been mostly allayed by a 10-year follow-up study.

Australian researchers found men assigned to watchful waiting or active surveillance for low-risk prostate cancers did not have poorer overall mental health than men who had active treatment.

Despite initially causing some distress to patients with low-risk prostate cancer, the study of 341 men interviewed between nine and 11 years after their initial prostate cancer diagnosis found that psychological outcomes and quality of life were generally similar between conservative and active treatment groups.

Men who opted for watchful waiting or active surveillance had higher levels of some psychological measures, but the differences were not significant overall.

Despite the higher initial levels of distress and hyperarousal, being assigned to active surveillance or watchful waiting “has only a minor impact on subsequent long-term psychological and quality of life outcomes”, the researchers concluded.

The bottom line was that men having active surveillance needed to be made aware that there were both benefits and costs, said study co-author Associate Professor David Smith, a senior research fellow at Cancer Council NSW.

"Active surveillance is a very appropriate treatment for many men with localised early stage prostate cancer, but having a well-rounded picture about the positives and the negatives is important," he said.

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Urological oncologist Associate Professor Nathan Lawrentschuk, from the Peter MacCallum Cancer Centre in Melbourne, said the findings were welcome because they confirmed that side effects and secondary effects of active surveillance and watchful waiting were minimal.

“We certainly need to do a better job of pushing out studies like this so the general public and GPs are aware that the majority of cancers we deal with can be treated effectively with monitoring rather than radical treatment,” Professor Lawrentschuk told Australian Doctor.

Professor Lawrentschuk said his patients were generally accepting of the concept of active surveillance, but it required good counselling because the word ‘cancer’ could be very emotive.

“I work on the traffic light theory with my patients. I explain to them: ‘Your biopsy is either going to come back as green, which is low-risk cancer that we watch, or it’s going to come back as red, which is high-risk cancer and we need to act,” he said.

“Or it might come back in the middle, and then we think about whether we can watch you or whether we have to act. But the vast majority of men come back with a green light,” he said.

“I think when you place it in those terms before you even do the biopsy, men are much more accepting of active surveillance before they even start,” he said.

More Information:

European Urology 2017; online.