Is watchful waiting the best choice for prostate cancer patients? According to a recent study from the Memorial SloanKettering Cancer Center in New York City, published in the Journal of Urology,prostate MRI testing can help doctors decide whether or not this less invasive option is the right way to approach a lowrisk prostate cancer patient. This was the first time the ability of an MRI to predict confirmatory biopsy results had been examined.
In the study, 388 men who were recently diagnosed with lowrisk prostate cancer were given an endorectal MRI. Radiologists then reviewed the MRI and assigned it a score. Then, the patients’ biopsy results were studied. Patients who had a low imaging score from an endorectal MRI had a greater than or equal to 95 percent negative predictive value and specificity for upgrading on biopsy. For those with a higher score, 90 percent had a correlation with upgrading.
Prostate cancer, when it is not growing or aggressive, is a very low risk disease. In fact,
many forms of prostate cancer do not behave like cancers at all, and as such do not need aggressive treatments.Watchful waiting, therefore, allows doctors to keep tabs on the tumors and determine when they need further treatment, if they ever do.
What does this data mean? This study shows that MRI can be an affective tool for the initial assessment of a patient to determine whether a watchful waiting approach is a safe course of action. Because watchful waiting requires identifying patients who have lowrisk disease, this is valuable information. Tumor visualization of highgrade disease only using MRI allows for a targeted prostate biopsy. MRI may help contribute to the assessment process in determining whether a patient is a candidate for a watchful waiting approach or focal therapy.
This is important information because so many newly diagnosed prostate cancer patients are overtreated. The National Comprehensive Cancer Network also recommends watchful waiting as a treatment option for patients who have lowrisk disease. When the life expectancy of the patient is at least 10 years, the risks and quality of life issues created by treating can often be worse than the tumors themselves.
While further research may be forthcoming, this shows, again, the fact that prostate cancer does not behave like a typical cancer, and as a result should be treated less aggressively until proven that it needs an aggressive treatment to prolong and save a patient’s life.