When Peter Bentey was diagnosed with prostate cancer, the doctor told him that he needed surgery. So did the doctor who gave him a second opinion. And the third. And the fourth.
Prepared to have his prostate removed, Bentey kept an appointment with Dr. H. Ballantine Carter, a Johns Hopkins urologist and oncologist. Carter looked at Bentey's blood work and did his own biopsy. The doctor's conclusion? Bentey had prostate cancer, but the New Jersey man did not need surgery. At least not right away.
Bentey's cancer appeared to be growing slowly, so Carter recommended a wait-and-see approach.
"He said, 'You're going to die someday, but I don't think it's going to be of prostate cancer,' " Bentey recalls.
That was in 2002. A couple of weeks ago, Carter gave him the all-clear for another six months.
Nearly half of the men diagnosed with prostate cancer in the United States have what is considered a low-grade disease, which many doctors say is unlikely to kill and does not require immediate treatment, be it surgery or radiation. But just a small fraction of those men - less than 10 percent, by most estimates - delay.
Instead they opt for what Carter and many others say could be unnecessary treatment with side effects that can harm urinary and sexual function.
"The knee-jerk reaction that everyone with prostate cancer needs curative intervention may not be the best approach," Carter said.
Leading prostate cancer experts agree that close monitoring of the disease - a process known in some circles as watchful waiting, in others as active surveillance - probably is the best course for a large number of men. But few long-term studies have been done to confirm that, because few men are willing to participate in research in which the cancer is left untreated.
Even longtime proponents of active surveillance say the wrenching decision of which avenue to pursue is complicated by the fact that some of the men who wait will end up with advanced cancer - and the small possibility that it cannot be cured.
"It flies in the face of the American approach to disease, which is, 'I've got to do something now,' " Carter said.
Dr. Ian Thompson, chairman of urology at the University of Texas Health Sciences Center, agrees. "Men look at prostate cancer and they think cancer - 'the Big C.' And they think, like pancreatic cancer and lung cancer, 'I must treat it,' " Thompson said. "But it's a different disease ... than many other cancers."
