Watch and wait: Major cancer group endorses active surveillance for prostate cancer

CHICAGO — Five years ago, when he was diagnosed with cancer, Kevin Brick gratefully accepted a doctor's offer to wait and see what happened to the tiny tumor in his prostate gland.

So far, there is no evidence the cancer is growing or becoming more aggressive.

"Everything seems to be going fine," says Brick, 60, whose doctor examines his prostate and administers tests every six months.

The approach is called active surveillance, and for the first time it's being endorsed for large numbers of men by a major medical organization: the National Comprehensive Cancer Network, an alliance of 21 leading cancer centers across the U.S.

In new guidelines, NCCN recommends active surveillance for men deemed to have "very low risk" prostate cancer and a life expectancy of less than 20 years. Also, the organization recommends the strategy if a man's prostate cancer is considered "low risk" and his life expectancy is less than 10 years.

Almost 40 percent of the 192,000 men diagnosed with prostate cancer each year could qualify for active surveillance under those standards, said Dr. James Mohler, chairman of the committee that prepared the guidelines and head of urology at Roswell Park Cancer Institute in Buffalo, N.Y.

NCCN's goal is to identify men likely to have slow-growing tumors and prevent unnecessary treatments that can render them incontinent or impotent.

"We know one in six men will be diagnosed with prostate cancer but only one in 40 men will die of prostate cancer," Mohler said. "It's obvious that we don't need to treat every single man with this condition."

The problem is that "we can't determine which prostate cancers are harmless," said Dr. William Catalona, director of the prostate cancer program at Northwestern University's Robert H. Lurie Comprehensive Cancer Center.

With active surveillance, there's a possibility that an aggressive cancer will be missed and the window for potentially life-saving treatment missed, he said.

By that logic, it's safer to intervene than adopt a "wait and see" strategy. And indeed, most doctors recommend surgery, radiation or other therapies, and more than 90 percent of patients follow their advice.

But there's mounting evidence that active surveillance works without adding to prostate cancer's death toll.