What's Old is New Again

The debate on the use of PSA in Pca continues. In a response to a recent NEJM article, a renowned researcher concludes:

For today, we can conclude on the basis of level 1 evidence2 that PSA monitoring, as compared with treatment of early prostate cancer, leads to increased metastasis. Therefore, if a man wishes to avoid metastatic prostate cancer and the side effects of its treatment,3 monitoring should be considered only if he has life-shortening coexisting disease such that his life expectancy is less than the 10-year median follow-up of the current study.2 In addition, given no significant difference in death due to prostate cancer with surgery versus radiation and short-course androgen-deprivation therapy, men with low-risk or intermediate-risk1 prostate cancer should feel free to select a treatment approach using the data on health-related quality of life3 and without fear of possibly selecting a less effective cancer therapy.

Yes, if one has a diagnosed PCa, or a PSA that is indicative of such, with subsequent positive biopsy, chances of not going with mets is not "watchful waiting" but acting.