Improving patient outcomes is a cornerstone of evidence-based medicine, a formalized means for the medical community to advance the science of medical care. Because prostate cancer can be slow-growing, many questions have arisen with regard to treatment, quality of life, and the frequency with which men should be tested (see Screening Tests for Adults: Prostate Cancer). Treatment decisions for what seems to be a slow-growing cancer must be made on an individual basis, considering factors such as the man’s age and life expectancy, PSA test results, biopsy findings, other medical conditions, psychological health and well-being as well as the latest knowledge on effective treatment. Several studies that are underway or soon to begin are aimed at answering some of the key questions involved and providing a stronger foundation on which doctors can more confidently recommend testing and, if necessary, a specific treatment.

The University of Texas M. D. Anderson Cancer Center announced in March 2006 that it will conduct a clinical trial to explore if low-risk patients can avoid or postpone therapy safely and effectively and still live as long as patients who immediately receive invasive therapy. The Cancer Center says this study of 650 patients will aid in development of clinical guidelines on watchful waiting. Regular PSA tests and digital rectal exams will be used to help monitor the patients.

The Prostate Cancer Intervention Versus Observation Trial (PIVOT) is taking place at over 50 Veterans Affairs Medical Centers and National Cancer Institute sites. Begun in 1994, this 15-year clinical trial is looking at how active treatment affects survival and quality of life in men of different ages. Specifically, this study of 731 men with early-stage prostate cancer is comparing radical prostatectomy to watchful waiting to find out which approach provides a longer life and better quality of life for men. The study is scheduled to continue until 2009, although some findings may be available sooner.

In addition, a 20-year study of 2100 men with low-risk, early-stage prostate cancer is starting in summer 2006 to compare active surveillance with other standard treatments, namely, surgery, internal radiation therapy (brachytherapy), and external beam radiation therapy. Called Standard Treatment Against Restricted Treatment (START), the trial is supported in part by the National Cancer Institutes of Canada and the United States.

Together, these studies are an important step toward filling crucial gaps in our knowledge about prostate cancer.

Sources
S1
Sometimes no treatment is the right option for low-risk prostate cancer: new study to explore if low-risk patients can avoid or postpone therapy safely and effectively (news release). 23 March 2006. M.D. Anderson Cancer Center. Available online. Accessed 11 April 2006.

S2
What is PIVOT? US Department of Veterans Affairs, National Cancer Institute, and the Agency for Health Care Research and Quality. Available at: http://www.va.gov/PIVOT/page5.html. Reviewed/updated 2/24/2003. Accessed 11 April 2006.

S3
Canadian Prostate Cancer Network. Goodbye watchful waiting. Hello active surveillance. Feb 2006. Available at: http://www.cpcn.org/archives/2006_02_05.htm. Accessed 17 April 2006.

S4
Parker-Pope T. Doctors seek to identify which patients can avoid prostate-cancer treatment. Wall Street Journal. 28 March 2006.

S5
US Department of Veterans Affairs. Watchful waiting—prostate cancer. Reviewed/updated 20 Jun 2005. Available at: http://www1.va.gov/psprostate_c/pagetext.cfm?pg=22. Accessed 11 April 2006.

S6
American Cancer Society. Detailed guide: prostate cancer. Expectant management (watchful waiting). Revised 10 March 2006. Available online. Accessed 11 April 2006

S7
National Cancer Institute. Treatment choices for early-stage prostate cancer. Available at: http://www.nci.nih.gov/cancertopics/prostate-cancer-treatment-choices. Accessed 19 April 2006.