Discussion
Guidelines developed in partnership with
This resource has been developed, reviewed or revised more than five years ago. It may no longer reflect current evidence or best practice.
Published: 2015
National Health and Medical Research Council
Chapter 5 Watchful waiting
Discussion
Unresolved issues
The optimal criteria for choosing watchful waiting have not been identified.
Emerging research may provide more information on the relative contribution of prostate cancer and other illness to cause of death among men undergoing watchful waiting.
Further follow-up data from SPCG-4 (see 5.1 Criteria for selecting watchful waiting) were published after the systematic reviews were completed for this guideline. The investigators reported that 200 of the 347 men in the radical prostatectomy group and 247 of the 348 in the watchful waiting group died during median of 13.4 years follow-up. Death was due to prostate cancer in 99 men assigned to watchful waiting and 63 men assigned to radical prostatectomy (p = 0.001).[1]
There is no high-quality evidence on which to base protocols for watchful waiting.
Studies currently underway
The SPCG-4[1] and PIVOT[2] studies are currently underway.
Future research priorities
Important unresolved questions for men with prostate cancer being managed with watchful waiting include:
- whether there are unmet needs and, if so, their rates and significance
- the optimal triggers and timing for starting anticancer treatment
- the optimal components and frequency of follow-up.
References
- ↑ 1.0 1.1 Bill-Axelson A, Holmberg L, Ruutu M, Garmo H, Stark JR, Busch C, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 2011 May 5;364(18):1708-17 Available from: http://www.ncbi.nlm.nih.gov/pubmed/21542742.
- ↑ Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, Fox S, et al. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med 2012 Jul 19;367(3):203-13 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22808955.