VA NY Harbor Healthcare System

Dr. William Blank has spent the last 10 years contributing to the cooperative effort of assembling the research described in the New England Journal of Medicine article.

Sometimes cancer arrives as a pussycat, and other times, a tiger. So, a patient often has to wait and watch according to Dr. William Blank, Chief of Urology at VA New York Harbor Healthcare System’s Brooklyn Campus. Dr. Blank is among the contributors to an article on prostate cancer that just appeared in The New England Journal of Medicine, one of the foremost publications of the medical profession.

“The article is very important in guiding the way men with prostate cancer are going to be treated medically," said Dr. Blank, who has spent the last 10 years contributing to the cooperative effort of assembling the research described in the article. The bottom line -according to Dr. Blank and his co-authors - is that radical prostatectomy, the removal of the entire prostate gland when cancer occurs, is usually not necessary for men in their 70’s and older because it doesn’t increase their survival.

VA does not perform, and has not for some time, this operation on Veterans above the age of 70. But the article presents evidence based Data that documents that the procedure makes little or no difference in the time the man lives or in his quality of life.

What about younger men? Are they being overly treated? The answer to that question is, “probably yes, although some are being treated appropriately,” said Dr. Blank. However, this article and the research data described does not address decisions about prostate cancer options in younger men.

Commenting more generally on the subject of prostate cancer, Dr. Blank said doctors and patients must go with the best that’s currently known about diagnosing and treating the disease. “While the PSA (involving a simple blood test) may not be the perfect test, it’s the best test available now to provide information about a patient's risk for prostate cancer.”

The approach, Dr. Blank prefers the term “watchful waiting,” for men of all ages with low risk prostate cancer only – meaning this option is advisable for men who have been diagnosed with a cancer that has not spread from the prostate and is in an early stage. The “watchful” part actually means conscientious monitoring by a physician of changes in the change in PSA rate, Gleason score and PSA density. A high PSA density means that a relatively small volume of prostate tissue is making a lot of PSA. If a cancer is determined to be growing rapidly, then a radical prostatectomy, radiation or seed implant therapy will be considered. For older men, the surgery should not be performed according to this recently published research, involving 731 men.