Watchful Waiting: A Viable Strategy for Men with Nonmetastatic Prostate Cancer and Short Life Expectancy

According to a recent study published in JAMA Network Open, watchful waiting is a suitable management strategy for men with nonmetastatic prostate cancer and a life expectancy of less than 10 years. The study found that watchful waiting was significantly associated with a low risk of prostate cancer progression and mortality among men with less than 10 years of life expectancy.

The Study

The study involved 5234 men with a life expectancy of less than 10 years at the time of diagnosis. Of this group, 27.5%, 33.3%, and 39.2% had low-, intermediate-, and high-risk disease, respectively. The median age at diagnosis was 81 years. Approximately one-third of patients were identified during prostate cancer screening.

The study found that men with low- or intermediate-risk prostate cancer could spend most of their remaining lifetime without receiving androgen deprivation therapy (ADT) and had a low risk of dying from prostate cancer. Men with low-risk disease and a 10-year life expectancy spent 82.1% of their remaining lifetime free from ADT, with a 13.3% risk of dying from prostate cancer. On the other hand, 21.8% of the high-risk group with a 10-year life expectancy died of prostate cancer, but they were still able to spend 59.8% of their remaining lifetime without receiving ADT.

After 10 years, castration-resistant disease developed in 4.1% of survivors in the low-risk group and 10.8% in the high-risk group. The team emphasized that “ADT has clinically relevant adverse effects, which not only impair quality of life but also increase comorbidity and possibly reduce life expectancy.”

Implications

Men who choose watchful waiting as a treatment strategy for prostate cancer may take reassurance from these results, as a large proportion of them may not experience cancer progression and might die of other causes. However, the team noted that men with high-risk cancer and low life expectancy may still want to consider primary treatment, but these patients should weigh the possible adverse effects.

As life expectancy increased from 1 to 10 years, so did the number of men receiving ADT, developing castration-resistant prostate cancer, and dying from prostate cancer, the investigators reported. Life expectancy was based on age, Charlson comorbidity index, and the drug comorbidity index. Furthermore, after 10 years, 92.3% and 84.1% of the remaining survivors in the low- and high-risk groups, respectively, died of causes other than prostate cancer.

Conclusion

Watchful waiting is a viable strategy for men with nonmetastatic prostate cancer and short life expectancy. It not only avoids the adverse effects of ADT but also carries a low risk of prostate cancer progression and mortality. However, men with high-risk cancer and low life expectancy may still consider primary treatment, taking into account the possible adverse effects.

Originally Post From https://www.renalandurologynews.com/news/watchful-waiting-ok-for-men-with-localized-prostate-cancer-low-life-expectancy/

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