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What is "watchful waiting" or active surveillance?

Although it may seem counter-intuitive, sometimes it's better not to treat prostate cancer right away. This treatment option has been termed watchful waiting in the past; today it is more commonly called active surveillance. It is a course of treatment that is only used for early stages of prostate cancer with low Gleason scores in which it is unclear whether the cancer will behave aggressively or grow slowly. In those cases, particularly in light of other factors like age and health, it can make more sense to just sit back and see what happens, thereby avoiding unpleasant side effects from treatment until they're absolutely necessary. If the cancer turns aggressive at any point, proper treatment with radiation, surgery, or chemotherapy can commence.
Marc B. Garnick, MD
Hematology & Oncology
In the past, doctors used the term "watchful waiting" to describe any strategy that involved following a prostate tumor to see if it worsened, whether or not there was a set schedule of testing. And while some practitioners of watchful waiting eventually had their cancer treated, others had no intention of doing so. Today, patients who monitor their cancer closely and plan to have treatment when its activity increases are said to be pursuing "active surveillance." Many doctors now use the terms "watchful waiting" and "observation" when patients don't plan to have treatment.

When is it safe to wait? There are a lot of factors to weigh and no definitive answer to this question. Until more information is available, one option is to postpone treatment but continue to have regular digital rectal examinations (DREs) (to monitor tumor growth) and periodic prostate-specific antigen (PSA) tests (to check for increases in blood levels that might indicate a progression of the cancer) and periodic repeat prostate biopsies. These follow-up tests should be scheduled every four to 12 months, depending on a man's age, biopsy results, and anxiety level. If PSA readings increase sharply or if the doctor feels a new lump during a DRE, the cancer may be advancing, and treatment can be reconsidered. A change in urinary habits can also signal that it's time to begin active therapy. Any man who tends to worry a great deal might prefer treatment over waiting and worrying, even if his tumor is slow-growing. And treatment might also make sense for men suffering from benign prostate enlargement.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.