Canadian researchers are launching a large, multi-year international study to try to find a way to help the hundreds of thousands of men diagnosed with prostate cancer every year decide whether to opt for potentially life-altering treatments or choose a watch-and-wait approach.The Canadian Cancer Society and the National Cancer Institute of Canada announced the study Thursday, saying it is hoped the START trial – the acronym stands for Surveillance Therapy Against Radical Treatment – will resolve one of the thorniest dilemmas in prostate cancer care.
“It’s answering some questions that we really need some answers to. Does active treatment at the time of diagnosis really make a difference in terms of long-term survival from prostate cancer?” explained Heather Logan, director of cancer control policy with the Canadian Cancer Society.
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I chose watchfulwaiting in 2001.
My Dad chose watchful waiting when he was diagnosed at age 80. He is now 89 and last year his prostate cancer metastisized to the bone. He had surgery and did fine and is now on Zometa and the Viadur patch. He had many years with no symptoms.
Following a raised PSA and positive biopsy, my partner chose watchful waiting in 2001- no scans were done at this time. The specialists watched his PSA rise slowly but steadily over the next 6 years. When it hit 13.8 earlier this year we decided the time had come for treatment. At our insistence we had scans done…these showed that the cancer had spread and is now no longer curable. There is a place for ww, but only if the condition is monitored properly with scans etc regularly
Why in the world is anyone still doing watchful waiting instead of an active surveillance, deferred therapy approach?
Watchful waiting seems to me to be just waiting to get clobbered. Active surveillance, in sharp contrast, involves monitoring the situation carefully in patients carefully selected to have a good chance of success with the approach, and timely intervention if the case takes a more aggressive turn. It also involves a supportive program of nutrition, exercise and stress reduction, perhaps also with low-key medications like finasteride. Leaders in active surviellance (by whatever name) at the U. of Toronto, Sunnybrook, Johns Hopkins, Memorial Sloan Kettering and the Erasmus Medical Center in the Netherlands are all reporting impressive success. Patients whose cases turn out to be more aggressive have had good results with timely treatment with intent to cure. MD Anderson has recently joined in reporting success.
I’m wondering if the START trial really involves active surviellance rather than watchful waiting. Dr. Laurence Klotz at the U. of Toronto, Sunnybrook, is one of the world leaders in active surveillance. He delivered a most interesting presentation on active surveillance to the ASCO conference, a presentation considered so important by the conference leaders that they scheduled it for the Education Book of key information for conference participants. I am not a member, so my access was limited to his slides and a recording of his verbal remarks. Both are available in the Education Book section for genitourinary diseases for the 2007 ASCO conference (www.asco.org). He presented a similar report as a panel member at the recent IMPaCT Conference in Atlanta (Innovative Minds in Prostate Cancer Today).
Jim
Thank you for sharing!