One of the problems with active surveillance, Dr. Catalona said, is that there is no consensus on when urologists should intervene. His concern is that waiting can mean delaying treatment, or worse - having patients become incurable.
"In anywhere from 15 to 30 per cent of the patients, when you remove the prostate, you find out it was a lot worse than you thought," Dr. Catalona said in a telephone interview from Chicago.
The problem for some men, especially those who are feeling healthy, is that a diagnosis of prostate cancer and a recommendation of surgery "turns their world upside down." That, he said, is why active surveillance is so attractive to many of them.
"Really the best thing, especially for a young person with a long life expectancy, is to get it out and never have to deal with it again," Dr. Catalona said. "[The surgery is] not bad if it's done by an experienced surgeon who has good results."
Though studies show roughly half who undergo the operation suffer erectile dysfunction afterward, a surgeon who specializes in the operation has much better outcomes.
Specifically, 95 per cent of men in their 40s who undergo the operation under Dr. Catalona will recover their erections; that figure drops to 85 per cent of men who get the surgery in their 50s and 75 per cent of men who undergo the operation in their 60s. Overall, incontinence is less than 5 per cent in his surgical hands.
In active surveillance programs, Dr. Catalona said: "Some patients are going to slip between the cracks and die a terrible death of prostate cancer. And that's awful."