early watchful eye is just as good as treatment for cancer

In the wake of a cancer diagnosis, deciding to sit back and see how things play out may seem like a ballsy move. But, if that diagnosis is for early-stage prostate cancer, it might be the smart one.
In a trial of 1,643 men diagnosed with early prostate cancer, those who actively monitored their cancer instead of immediately starting treatment had the same minuscule risk of death in a ten-year study as men who underwent either radiation therapy or surgery straightaway. The finding, reported Wednesday in the New England Journal of Medicine, suggests that it’s safe to hold off on the often slow-growing cancer when its caught early and only seek treatments—which can have devastating side effects, including incontinence and impotence—if the disease progresses.
Disease progression (i.e. the cancer grows and spreads to other parts of the body) was more common among the 545 men randomly assigned to the monitoring group. About half ended up getting either radiation or surgery by the end of the ten-year study. However, they still had the same low death rate from the cancer as the radiation and surgery groups—about one percent. And the remaining portion that didn’t progress and go through treatments were able to dodge needless side effects.
The authors of the study, led by researchers at the University of Oxford, are still monitoring the patients to see if benefits of holding off hold up over time.
Treatments definitely keep the disease from progressing, lead author Freddie Hamdy, of Oxford, emphasized in a statement. “But we do not know yet whether this will make a difference to them living longer or better, and we have been unable to determine reliably which disease is lethal, and which can be left alone.” Still, he added, what the study shows so far is that early prostate cancer—detected by a blood test—grows “very slowly, and very few men die of it when followed up over a period of 10 years… irrespective of the treatment assigned.”
For older men, who may not live much beyond ten years regardless of prostate cancer, the findings may be a clear enough conclusion. The men in the study were between 50 and 69 years old, with an average age of 62. In the US, the average age at diagnosis is 66. Experts estimate that there will be about 181,000 new prostate cancer diagnoses and 26,000 deaths in the country during 2016. And already, around half of those diagnoses are opting for monitoring.
This active surveillance, as doctors call it, require regular clinic visits for physical exams, biopsies, and blood tests for prostate-specific antigen (PSA) levels, rising levels of which can indicate worsening disease.
The other options are either radiation or surgery. In the study, researchers noted that those who were randomly assigned to surgery were the most likely to suffer from lingering impotence and incontinence. Those given radiation therapy, which was coupled with a hormone therapy that starves cancer cells, had lingering bowel problems and some lingering problems with impotence.
While previous research has hinted that prostate cancer may not be a life-sentence warranting immediate treatment, the new study is the first to compare monitoring with the two modern treatments.