Prostate cancer is a common diagnosis among men, particularly as they age. While some prostate cancers are aggressive and require immediate intervention, many are slow-growing and may not pose an immediate threat to a man’s health or lifespan. In such cases, watchful waiting may be considered. This approach observes the cancer over time without immediate curative treatments, allowing individuals to avoid or delay the side effects of active cancer therapies.
Understanding Watchful Waiting
Watchful waiting monitors prostate cancer without immediate curative treatment. Its primary goal is to manage symptoms if they arise, rather than to eradicate the cancer itself. This approach is considered for men with a limited life expectancy due to age or other health conditions, or for those with very slow-growing, low-risk cancer unlikely to cause problems during their lifetime. It differs from active treatment, which aims to cure the cancer, by prioritizing quality of life and avoiding the potential side effects of aggressive therapies. For many men, prostate cancer can be so slow-growing that it may never cause issues or symptoms, offering an alternative to immediate treatment.
Candidate Considerations
Watchful waiting is not suitable for all prostate cancer patients; specific criteria guide its consideration. It is recommended for men whose prostate cancer is not causing symptoms and is unlikely to cause problems during their expected lifespan. Factors like age and overall health, including other significant medical conditions, determine suitability. For instance, if a man has serious illnesses that limit his life expectancy, immediate aggressive treatment for prostate cancer may not offer significant benefit.
The cancer’s characteristics are also important. Watchful waiting is considered for localized, low-grade, and slow-growing prostate cancer. This means the cancer is confined within the prostate gland and appears less aggressive under microscopic examination. A low Gleason score, often 6 or 7, indicates that cancer cells resemble normal prostate tissue and are less likely to spread quickly. Conversely, watchful waiting is not an option for fast-growing cancers or those likely to spread beyond the prostate.
Monitoring and Management
Once watchful waiting is chosen, monitoring involves a less intensive schedule. Patients have regular check-ups, often including an annual Prostate-Specific Antigen (PSA) blood test. This test measures a protein produced by prostate cells, and significant changes can indicate cancer progression. Some doctors may also recommend a digital rectal examination (DRE) periodically.
The focus of monitoring is primarily on the development of symptoms. Patients are advised to report any new or worsening symptoms, such as urinary problems or bone pain, which could signal cancer growth or spread. Unlike more intensive surveillance, routine imaging scans or repeat prostate biopsies are not part of the protocol unless symptoms arise or PSA levels show concerning changes. If symptoms develop, treatment would then manage those symptoms and improve comfort, rather than aiming for a cure.
Distinguishing From Active Surveillance
Watchful waiting and active surveillance both monitor prostate cancer without immediate treatment, but they differ significantly in their goals and intensity. Active surveillance aims for curative treatment if the cancer shows signs of progression, and it involves more frequent and intensive monitoring. This typically includes regular PSA tests, digital rectal exams, and often repeat biopsies and imaging tests like MRI scans, usually every 3 to 12 months. Active surveillance is generally for younger, healthier men with low-risk localized cancer who could benefit from curative treatment if needed.
In contrast, watchful waiting is a more passive approach, primarily focused on symptom management rather than cure. It involves less frequent testing, often just an annual PSA test, and relies on symptom development to trigger intervention. Watchful waiting is usually recommended for older men or those with other serious health conditions that make them less suitable for curative treatments due to potential side effects. The intent is to avoid the burdens of treatment for a cancer that may never cause significant problems during a patient’s natural lifespan. While active surveillance proactively seeks signs of progression to intervene with curative intent, watchful waiting only addresses symptoms if they become bothersome, with treatment focused on palliation rather than eradication.
Making the Decision
Deciding on watchful waiting involves a careful discussion between the patient and their healthcare provider, considering individual circumstances and preferences. This shared decision-making process weighs the benefits of avoiding immediate treatment against the risks of cancer progression. Factors such as a patient’s age, overall health, and personal values regarding quality of life play a significant role. Many men choose watchful waiting to avoid the potential side effects of active treatments, such as urinary incontinence, erectile dysfunction, and bowel problems.
Living with untreated cancer can bring emotional challenges, including anxiety. A patient’s comfort level with the monitoring approach and ability to manage potential stress are important considerations. The watchful waiting strategy might be re-evaluated if symptoms develop, PSA levels significantly rise, or if other evidence of cancer progression, such as an increase in Gleason score on a biopsy, appears. At such points, the discussion might shift towards initiating treatments to manage symptoms or, in some cases, considering active therapy depending on the patient’s health and the cancer’s behavior.