Watchful Waiting for Prostate Cancer

Watchful waiting, also known as active surveillance or expectant management, is a treatment approach for prostate cancer that involves closely monitoring the disease with regular check-ups and tests, rather than immediately treating it with surgery, radiation, or other therapies.

Who is a Candidate for Watchful Waiting?

Watchful waiting is typically recommended for men with:

• Low-risk prostate cancer, which means the cancer is small, slow-growing, and has not spread beyond the prostate gland
• Early-stage prostate cancer that is not causing symptoms
• A limited life expectancy due to other health conditions, making it unlikely that the prostate cancer will cause problems during their lifetime
• Men who are older or have significant health issues that make them poor candidates for surgery or radiation therapy

What Does Watchful Waiting Involve?

Watchful waiting typically involves:

• Regular prostate-specific antigen (PSA) blood tests to monitor the level of PSA in the blood, which can indicate if the cancer is growing or spreading
• Digital rectal exams (DREs) to check for any changes in the prostate gland
• Periodic biopsies to check for any changes in the cancer cells
• Regular imaging tests, such as ultrasound or MRI scans, to monitor the size and location of the tumor
• Regular follow-up appointments with a healthcare provider to discuss any symptoms, test results, and treatment options

Risks and Benefits of Watchful Waiting

The benefits of watchful waiting include:

• Avoiding the potential side effects of surgery or radiation therapy, such as incontinence, impotence, or bowel problems
• Preserving quality of life by avoiding treatments that can have significant side effects
• Allowing men to maintain their normal activities and lifestyle without interruption

The risks of watchful waiting include:

• The possibility that the cancer may grow or spread during the monitoring period, which could make treatment more difficult or reduce the chances of a cure
• The potential for delayed treatment to affect the outcome of therapy, if the cancer is eventually treated
• Anxiety and uncertainty about the disease and its progression

When to Consider Treatment

Treatment may be considered if:

• The PSA level increases significantly over time
• The cancer is found to have grown or spread during monitoring
• New symptoms develop, such as pain, difficulty urinating, or erectile dysfunction
• The patient's overall health changes, making treatment more feasible or necessary

Treatment options for prostate cancer include surgery, radiation therapy, hormone therapy, and chemotherapy. The choice of treatment depends on the individual case and should be discussed with a healthcare provider.