watchful waiting



Watchful waiting, the prostate cancer treatment dilemma

Whether to treat prostate cancer is one of the biggest dilemmas for today patients, especially those who are feeling healthy yet.

It is a fact that prostatectomy or other prostate cancer treatment turns man's world upside down. All studies show roughly that about one half of patients become impotent right afterward surgery or 2 years of having radiation therapy. Many men are left with lack of urination control (incontinence).

What means watchful waiting?

It is known that many prostate cancers are not aggressive, they are small and grow slowly. A man with a slow-growing tumor has almost the same life expectancy as a man who doesn't even have prostate cancer. Any man having prostate cancer growing slowly still can enjoy his masculinity.

Why to treat it, then? active surveillance

Some doctors instead recommend watchful waiting or active surveillance. Within watchful waiting, prostate cancer gets no treatment, but patient must see the doctor often for regular digital rectal examinations, PSA tests or needle biopsies every 6-12 months. The watchful waiting means to monitor signs of the prostate cancer. If there's no evidence the cancer is growing, patient continues to get no treatment. Only if signs worsen, such as:

  • prostate cancer is found in a greater number of biopsies or
  • primary Gleason grade 4 or 5 is found upon repeat biopsy or
  • PSA doubling time is les than 3 or
  • PSA velocity is greather than 0.75
    means that cancer starts grow and needs treatment.

    What are the benefits of watchful waiting?

  • No need for invasive treatment or surgery. In many cases, men can live with slow-growing prostate cancer for their entire lives.
  • Avoid possible side effects of therapy that may be unnecessary
  • Quality of life retained
  • Patients can enjoy normal activity

    What are the risks and disavantages of watchful waiting?

    Watchful waiting doesn't mean the man is completely healthy. Therefore, the main risk is the possibility to ignore the medical monitoring of disease and to miss the opportunity for right cure. We can also list the followings:

  • Risk of cancer progression
  • Subsequent treatment may be more aggressive with increased side effects
  • Frequent exams and screenings are required
  • Anxiety caused by uncertain history and term of prostate cancer

    Is watchful waiting the best option every time?

    Many studies suggest that about half of newly diagnosed prostate cancer patients are eligible for active surveillance. The truth is watchful waiting is up to patients choice, especially if they are young or feel that the side effects of treatment outweigh the benefits. At the same time, older men with early-stage prostate cancer are not taking a big risk if they keep an eye on the disease for a while instead of treating it right away.

    Active surveillance is particularly useful for men with low-risk prostate cancer who are more elderly. It is not generally recommended for younger men with this disease below the age of 60 because they have potentially longer life spans when the cancer can become a problem.

    One after another, the new opinion is that watchful waiting prostate cancer should be the first option, unless there are strong evidence that tumor is very aggressive.

    Latest news

  • Active surveillance safe for some prostate cancers
    A new study at Memorial Sloan-Kettering Cancer Center, New York, reports carefully selected men with "low-risk" prostate cancer can safely delay treatment and opt instead for active surveillance. [ read full article ]

  • Watchful waiting may be the right option to treat prostate cancer
    For most men 80 and older the chances are very good to have some prostate cancer cells. But decisions on what treatment to choose or even whether to treat depend on the individual and his cancer. That means that some prostate cancer patients may find "watchful waiting" is the best option for dealing with it. [ read full article ]

  • 'Watchful Waiting' often best strategy for slow-progressing prostate cancer
    According to a large-scale study from Sweden, for patients with prostate cancer that has a low risk of development, watchful waiting, also known as "active surveillance," may be a suitable treatment option. [ read full article ]

  • Prostate tumors not likely to worsen during active surveillance period in low risk patients
    Johns Hopkins experts have found that men enrolled in an active surveillance program for prostate cancer that eventually needed surgery to remove their prostates fared just as well as men who opted to remove the gland immediately, except if a follow-up biopsy during surveillance showed high-grade cancer. [ read full article ]

  • New update of active surveillance for prostate cancer
    Active surveillance, also referred to as watchful waiting, is a viable option for many men with low risk prostate cancer although the concept continues to cause distress and confusion. [ read full article ]

  • NCCN updates recommend the value of active surveillance
    The updated NCCN clinical guidelines for prostate cancer now include an explicit recommendation for active surveillance (watchful waiting) and only active surveillance for many men diagnosed with prostate cancer. [ read full article ]

  • Who is really a candidate for active surveillance (watchful waiting)
    Today, urologists agree that is not yet well-defined who is really a candidate for active surveillance (watchful waiting) as opposed to early treatment for prostate cancer that is supposedly localized. [ read full article ]

  • Prostate cancer survivors who would be eligible for active surveillance but were either treated with radiotherapy or managed expectantly
    Men diagnosed with low-risk localised prostate cancer often face the difficulty of choosing an appropriate treatment. Localised prostate cancer can be treated curatively or managed expectantly with active surveillance (AS). [ read full article ]

  • Anxiety and distress during active surveillance for early prostate cancer
    This study found that the majority of men with early prostate cancer (PC) included in a protocol-based program for active surveillance (AS) show favorable anxiety and distress scores when compared to reference values and to groups of patients with PC who underwent other treatments. [ read full article ]

  • Watchful waiting safe for some prostate cancer
    Researchers of Memorial Sloan-Kettering Cancer Center, New York, report in the April issue of The Journal of Urology that carefully selected men with "low-risk" prostate cancer can safely delay treatment and opt instead for active surveillance. [ read full article ]

  • Update on watchful waiting versus radical prostatectomy
    In 2005, the Scandinavian Prostate Cancer Group Study 4 (SPCG-4) reported that radical prostatectomy improved prostate cancer survival compared with watchful waiting after a median of 8.2 years of follow-up. [ read full article ]

  • Selected men with low-risk prostate cancer have good clinical outcomes without immediate treatment
    A multi-center study of prostate cancer patients appearing in today's Journal of Urology recommends that for some men diagnosed with low-risk prostate cancer, opting not to initially receive treatment can be safe if they are closely monitored. [ read full article ]

  • Prostate cancer: When to wait and when to treat
    Researchers at Fred Hutchinson Cancer Research Center have a lead role in a new public/private partnership to create the first systematic surveillance program of men with prostate cancer to look for biological clues to help determine when to wait and when to treat the disease. [ read full article ]



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    NOTE: Issues on this site regarding prostate cancer and treatment options, are provided for information only, and are not meant to substitute for the advice of your own physician or other medical professional. Prostate-Report.org does not endorse any specific product, service or treatment.





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