What is watchful waiting in context to prostate cancer?

Some men choose to receive no therapy for their prostate cancer in the hopes that it will grow very slowly. This is called watchful waiting. By avoiding any therapy, they avoid the side effects that come along with surgery, radiation or hormones.

Watchful waiting is appropriate for older men with small, low-grade tumors, slowly rising prostate-specific antigens (PSAs) and those who have multiple health issues. Watchful waiting can be considered in patients who are expected to live less than 10 years. This is only if the cancer isn't large or of a high grade.

Men who choose watchful waiting should have PSAs and digital rectal exams done every 3 to 6 months. They will also need to have biopsies of the prostate to make sure the grade hasn't become less favorable. With watchful waiting, it is never clear what change should be the signal to begin treatment. Also, if the tumor has progressed, the patient may no longer be eligible for curative therapy.

Watchful waiting for prostate cancer can be an effective and reasonable treatment strategy, especially for an older man who has a slow-growing, early-stage tumor and/or who has other serious health problems that require treatment more urgently or that make treating the prostate cancer too risky. Watchful waiting may be recommended for men in whom the risks of treating prostate cancer outweigh the benefits.

If you choose watchful waiting, your doctor will closely monitor you to be sure your prostate cancer is not growing or spreading. During a period of watchful waiting, the doctor may order PSA (prostate-specific antigen) blood tests, rectal examinations and ultrasound exams to monitor the tumor carefully. If the tumor remains small, your Gleason score (a grade reflecting presence and pattern of cancer cells) remains low, and you are not experiencing any symptoms, you can usually continue with watchful waiting. If you begin to have symptoms or tests show the cancer is starting to progress, you can start treatment at that point.

Watchful waiting involves no medication. Instead, your doctor tests periodically to see if the cancer is growing. Watchful waiting is suggested for:

• early stage prostate cancer that seems to be growing slowly;
• older prostate cancer patients or those with serious medical problems that may make the risks of treatment outweigh the possible benefits.

Watchful waiting is an older term and is not the same as active surveillance of prostate cancer. Watchful waiting is a situation in which a man is diagnosed with prostate cancer but does not receive any treatment until he has symptoms, such as pain. Then he receives medical treatment. In active surveillance, a man is carefully monitored so that his cancer does not progress beyond the treatable stage.