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Could you live with untreated prostate cancer?

Consumer Reports News: August 04, 2009 10:12 AM

In the U.S., the number of men diagnosed with prostate cancer peaked sharply in the early 1990s, possibly because of the introduction of PSA testing. Although rates have fallen since then, doctors still expect to see more than 190,000 American men diagnosed with prostate cancer during 2009.

Any diagnosis of cancer is frightening, but men with prostate cancer face some particularly difficult choices. Many prostate tumors are slow-growing; so much so that they'll never get big enough to cause any harm. You can see this from autopsy results. About 60 in 100 men have cancer cells in their prostate when they die, although many of these men will have died of something else.

It's often difficult to tell whether prostate tumors are slow- or fast-growing. Why not treat them all, just to be sure? Unfortunately, treatment with surgery or radiation therapy can cause side effects that most men would rather avoid, such as erection problems and incontinence.

For early stage prostate cancer, doctors increasingly recommend a wait-and-see approach, which they call active surveillance (subscribers only). You have regular tests, and if your cancer becomes more aggressive, you start treatment. If it doesn't, you avoid the side effects of surgery or radiation therapy. However, this approach does mean living with untreated cancer. Even the bravest of men could be forgiven for finding that idea frightening.

Some comfort is offered by a new study, which looked at 129 men with prostate cancer who chose a wait-and-see approach to treatment. They all filled out questionnaires about their levels of depression and anxiety. About 8 or 9 out of 10 men had fewer worries than a typical, healthy person, and most of them had a similar or better emotional state compared with men having other treatments for prostate cancer.

The study suggests that most men who choose active surveillance cope well, although it's worth remembering that the men were taking part in a clinical trial, so probably got closer attention than a typical patient. This might mean they had fewer anxieties about their care. In fact, some men said that filling in the questionnaires made them feel better, because they appreciated that the researchers were interested in their feelings.

What you need to know. If you've been diagnosed with prostate cancer, your feelings about treatment will be deeply personal. If your doctor thinks that active surveillance could work for you, it may help to know that the majority of men seem to cope well with that approach.

Philip Wilson, patient editor, BMJ Group has partnered with The BMJ Group (British Medical Journal) to monitor the latest medical research and assess the evidence to help you decide which news you should use.

If you've been diagnosed with prostate cancer, here are some questions to ask your doctor. Take a look at new research on the prostate-cancer screening, and for more on the effectiveness of active surveillance and surgery for prostate cancer, see our Treatment Ratings (subscribers only). And for cost savings on drugs to treat enlarged prostate, see our free Best Buy Drugs report

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