Patients who choose watchful waiting
are choosing to actively monitor the growth of their
cancer, rather than actively pursue destroying it.
Some patients are not comfortable with watchful waiting
and would rather destroy the disease now despite the
side effects. But those who do choose watchful waiting
as their prostate
cancer treatment benefit from holding off treatment
until the disease begins to grow more rapidly or aggressively.
There are men who have not started more aggressive prostate
cancer treatments until 10 to 15 years after their initial
diagnosis. Patients who are considering watchful waiting
should remember that most cases of adenocarcinoma
of the prostate grow very slowly.
Most patients will see their doctors for the prostate-specific antigen (PSA) test and a digital rectal exam (DRE) every six months. Immediately after receiving a diagnosis, patients will see their doctors every 3 months. Doctors who are monitoring the PSA level are looking for an accelerated velocity in serum prostate-specific antigen, meaning the amount of PSA that is in the bloodstream. If the cancer begins to grow rapidly in between doctor’s visits, the level of serum prostate-specific antigen will increase. The doctor notes the increased velocity and may determine that the patient should immediately receive another prostate biopsy. If the biopsy indicates an increase in the number of cancerous cells that results in a high Gleason score, the patient will probably begin more aggressive treatment.
Those who are candidates for watchful waiting will probably not have had palpable tumors in their digital rectal exams at the time of their diagnoses. Doctors will perform a digital rectal exam during each check-up to see if there is a change in the growth of the prostate gland. A sudden irregularity, such as new firmness, jaggedness, or lumpiness, is grounds for a repeat biopsy. If the prostate biopsy reveals a higher Gleason grade, the patient may have to pursue more aggressive treatments.
A doctor may also order repeat prostate biopsies every year or so. The prostate biopsy is one of the clearest indicators of whether a patient needs to begin another form of prostate cancer treatment. Immediately after the diagnosis, a doctor may also order a second biopsy to confirm the Gleason score. It is possible that the core samples taken during the biopsy do not accurately represent the extent of cancer there within the prostate. Many men who are not diagnosed and who receive the prostate biopsy will have negative results. Based on family history, PSA velocity, and other risk factors, a doctor may order a second biopsy. Follow-up biopsies are sometimes necessary to determine whether a patient truly is a candidate for watchful waiting.
Some doctors may encourage their patients to seek counseling to supplement their watchful waiting. A diagnosis of any type of cancer will rightfully provoke anger, fear, depression, and other negative emotions. Patients who feel that watchful waiting is the right choice for them, but feel stress or helplessness from not pursuing a more aggressive treatment, may want to speak to their doctor about whether counseling can help them.