Recently, research published in the New England Journal of Medicine summarized a number of studies involving watchful waiting. In these studies, the article’s authors reported, the men treated with watchful waiting were carefully selected from a large group of patients because they were felt to have slow-growing cancers that were unlikely to spread. These patients were not representative of the usual patient who walks into a doctor’s office—in other words, they were almost all “best-case scenarios.” Even so, ten years later, 40 percent of the men in these elite groups who had Gleason scores from 5 to 7 had developed metastases to bone, and by fifteen years, 70 percent had developed these metastases. (The survival time for patients with metastases to bone is about two to three years.) These observations drive home two points: One is that prostate cancer marches on; it continues to progress in most patients— even in those with the mildest-looking disease. And the other is that if a man with localized prostate cancer does not get effective treatment, and if he lives long enough, he will very likely die of prostate cancer.
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