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Watchful waiting is not a euphemism
for doing nothing, but rather it is the decision to delay treatment
in favor of careful monitoring for the progression of prostate
cancer. Watchful waiting may also be referred to as
expectant management, conservative management, observation,
or active surveillance.
The theory behind watchful waiting
treatment is that most prostate cancers, specifically
prostate adenocarcinomas, usually grow very slowly.
Patients who have low Gleason scores, other medical
complications, or low grade tumors may wish to postpone
treatment due to the side effects. The standard that
most doctors use when recommending watchful waiting
is a ten years life expectancy. If a
patient can reasonably expect to benefit from a more aggressive treatment
for a period of ten years or more, doctors may recommend
pursuing other treatments now. Patients who are older
or who wish to avoid the side effects of incontinence
and impotence that usually come with other treatments
may opt for watchful waiting.
Watchful waiting will tell you and
your doctor how quickly your prostate cancer is progressing,
or if the disease is progressing at all. PSA tests are
usually taken every three months to monitor a change
in PSA velocity. Doctors usually recommend that patients
receive biopsies in a year. Patients also receive regular
DRE’s which will detect any new regularities that
may indicate the progression of prostate cancer.
Patients who choose to undergo watchful
waiting will be able to avoid the side effects and prolong
their current activities and physical state. Patients
may also be able to make lifestyle changes in their
exercise and diet, which may help slow the progression
of prostate cancer even more. Positive changes in diet
and exercise will also benefit the patient’s overall
physical and mental well being. Some doctors say that
patients may not benefit from watchful waiting if thought
of postponing treatment causes high levels of anxiety
and distress that interfere with daily life.
Patients opting to undergo watchful
waiting should be aware that prostate cancer usually
grows slowly. However, slow growth is not the rule of thumb
for all prostate cancer cases. Careful monitoring by
experienced physicians can help a patient receive the full benefit
of watchful waiting. There is always a chance, though,
that prostate cancer will metastasize or rapidly grow
in between checkups. The frequent checkups are to minimize
the likely hood of unmonitored prostate cancer growth.
Watchful waiting can also be used
as treatment for recurrent prostate cancer. If a patient
is free of biochemical failure for several years, meaning
his PSA levels stay well below 0.5ng/mL, and then suddenly
increases, or if the doctor finds irregularities during
a DRE, watchful waiting may be a good choice. Especially
for older patients or those with other health problems
who do not wish to go through treatments and
side effects, watchful waiting may be the first choice
for salvage treatment. Many doctors urge their patients
to pick which treatment would most benefit them and
their lives. Because prostate cancer often does grow
slowly, it is not uncommon for patients to chose watchful
waiting as their salvage therapy.
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