Metro Urology

What is watchful waiting. What are we watching? What are we waiting for?

Some types of prostate cancer grow very slowly, and it may take years before that cancer develops and spreads to other parts of the body. Because many of these cancers grow slowly the adage that “men die with and not of prostate cancer” holds true in many cases. Older men, or men who have many other health problems may benefit from a surveillance approach to determine that there cancer is growing more quickly or aggressively before embarking on treatment. This is not a “do nothing” approach to prostate cancer; it does not mean that we ignore the cancer. Watchful waiting requires regular, scheduled appointments with a prostate cancer specialist to determine whether the cancer is getting larger or is growing more quickly. Only your doctor can help you determine if your cancer has become more aggressive; it is imperative that you develop a reasonable plan for surveillance and plans for when to start treatment in the future.

AM I A CANDIDATE FOR WATCHFUL WAITING?

Your doctors will help you determine this. Men with nonaggressive cancers who expect to live fewer than 5-10 years will probably benefit from this approach. Nonaggressive cancers usually have a Gleason Score of 2-5. A man living today is generally expected to live 80 years so most men who choose watchful waiting are above 70, but younger men suffering from diseases such as severe heart or lung disease may also be expected to live less than ten years.

WHAT ARE THE ADVANTAGES OF WATCHFUL WAITING?

By choosing surveillance, men can avoid the potential complications of other treatments while running a low risk of having the cancer grow and spread. Because prostate cancer does not usually cause symptoms until it grows to a large stage most men are able to live their lives as they have always done after they choose this approach, deferring the costs and recovery of the more aggressive treatments for when they absolutely need it.

WHAT ARE THE DISADVANTAGES?

Unfortunately we cannot predict in all cases when a cancer is going to grow or spread more quickly. We know that some men will have the cancer spread to the bones, need hormone, chemotherapy, or radiation treatments to help control the cancer. In general, for patients with the slowest growing cancers, 5-7% of patients within 5 years an 10-20% of patients within 10 years will need one of the additional therapies listed above.

HOW IS WATCHFUL WAITING PERFORMED?

Watching the cancer requires regular checks on your general health, rectal exams to evaluate changes in the prostate, and PSA blood tests. The typical schedule will be doctor visits every six months. Sometimes repeat prostate biopsies or x-rays are needed to help determine whether the cancer has become more aggressive. Your doctor can help you come up with a plan that is more appropriate for you.