What's the evidence for watchful waiting - Watchful Waiting (Expectant Therapy)

BMJ Group, Monday 13 October 2008
Article history
We found two good-quality studies (called randomised controlled trials) that compared watchful waiting with other treatments for cancer that hasn't spread. These show that most men with an early-stage tumour who choose watchful waiting still have a good chance of surviving the disease.

The first study involved 142 men with prostate cancer who were treated with either watchful waiting or surgery. After 23 years, the men treated with watchful waiting were just as likely to be alive as those who had surgery.[2] But the study had too few men for us to be certain about the results. It's also fairly old and used surgical techniques that may not be as good as those we use today.

The second study was much larger, and so the results are more reliable. It involved 695 men who also had either watchful waiting or surgery. After six years, the men treated with watchful waiting were just as likely to be alive as those who had surgery. But the men treated with surgery were less likely to have died from prostate cancer.[1]

But a follow-up of this study, published more recently, found that eight years on, the men who had surgery were less likely to have died, either from prostate cancer or other causes, than men who chose watchful waiting.[3] It also found that the cancer was less likely to have spread in men who had surgery.

References

Holmberg L, Bill-Axelson A, Helgesen F, et al. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. New England Journal of Medicine. 2002; 347: 781-789.

Iversen P, Madsen PO, Corle DK. Radical prostatectomy versus expectant treatment for early carcinoma of the prostate: twenty-three year follow-up of a prospective randomized study. Scandinavian Journal of Urology & Nephrology. 1995; 172 (supplement): 65-72.

Bill-Axelson, Holmberg L, Ruutu M, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. New England Journal of Medicine. 2005; 352 : 1977-1984.