Pinpointing Patients Who Require Aggressive Treatment

Drs. Richard Choo and Laurence Klotz (1997 Research Grant)

One of the most influential prostate cancer studies was funded by the Foundation almost a decade ago. It was a long-term study on watchful waiting by Drs. Richard Choo and Laurence Klotz.

Although most prostate cancer is slow growing, some cases are aggressive and warrant immediate radical treatment. In the absence of a crystal ball, doctors and patients are faced with a treatment dilemma: fight the disease with radical treatments that can lower quality of life or exercise watchful waiting and risk missing the opportunity for a cure?

In a phase II clinical study, the researchers tested a novel approach. They used a man’s PSA doubling time to choose a treatment path. The study found that men with “favourable risk” prostate cancer (gleason score of 6 or less, PSA less than 10 and cancer stage T1c to T2a) can be safely monitored with watchful waiting and almost all of them will die of unrelated causes. This finding is significant because half of new diagnoses fall into this category. The study suggests that at least 40 per cent of men can be spared the debilitating effects of radical treatment without sacrificing life expectancy.

Although it is still ongoing, the study has already had a huge impact on patient care. A larger phase III trial is now taking place in Canada, the USA, UK and Europe.

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