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Because prostate cancer often grows very slowly, some men
(especially those who are older or have other serious health problems)
may never need treatment for their prostate cancer. Instead, their
doctors may recommend an approach known as expectant management, or
"watchful waiting." This approach involves closely monitoring the
cancer without active treatment such as surgery or radiation therapy.
It may be recommended if your cancer is not causing any symptoms, is
expected to grow very slowly, and is small and contained within one
area of the prostate.
Watchful waiting is less likely to be a good option if you are
young, healthy, and/or have a fast-growing cancer (for example, a high
Gleason score).
At this time, watchful waiting is a reasonable option for some
men with slow-growing cancers because it is not known whether treating
the cancer with surgery or radiation will actually help them live
longer. These treatments have definite risks and side effects that may
outweigh the possible benefits for some men. Some men are not
comfortable with this approach, and are willing to accept the possible
side effects of active treatments in order to try to remove or destroy
the cancer.
Watchful waiting does not mean that you will not receive
medical care or follow-up. Rather, your cancer will be carefully
monitored. Usually this approach includes a doctor visit with a PSA
blood test and digital rectal examination (DRE) about every 3 to 6
months. Transrectal ultrasound-guided prostate biopsies may be done
every year as well. If you develop bothersome symptoms or your cancer
begins to grow more quickly, you can consider active treatment. A
possible downside of this approach is that there's a chance it could
allow the cancer to become more advanced, which might limit treatment
options.
Hopefully we will have a better idea of the pros and cons of
watchful waiting versus active treatment in the near future. A large
study sponsored by the National Cancer Institute and the Veterans
Affairs Cooperative Studies Program is now looking into how active
treatment affects survival and quality of life of prostate cancer
patients of different ages. The PIVOT (short for Prostatic Intervention
Versus Observation Trial) is still in progress.
Last Medical Review: 08/25/2008
Last Revised: 05/13/2009
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