for decision making when treatment does not clearly pro-
vide a survival advantage. For example, older men with
slow- growing, early prostate cancer can choose “watch-
ful waiting” (monitoring with no treatment), rather than
prostatectomy or radiation, based on the assumption that
comorbid conditions will end their lives before the can-
cer will. A randomized trial of watchful waiting vs radi-
cal prostatectomy found that all-case mortality was not
significantly different in the two groups, even though the
rate of death from prostate cancer was slightly lower in the
prostatectomy group.
In a companion study, quality of life
outcomes were assessed an average of 4 years after random-
ization.
The prostatectomy group had significantly greater
urinary leakage and compromised sexual function. These
results are important for older men to consider when diag-
nosed with prostate cancer, so that they can make informed
decisions regarding treatment.