Watchful waiting and prostate cancer

Watchful waiting, which is also sometimes called “expectant management” or “active surveillance,” is when your loved one’s doctor doesn’t start any treatment, but carefully monitors the growth of the cancer. However, these terms may have different meanings depending upon the doctor, so it's important to ask the doctor what his/her definition of watchful waiting is.

It is generally discussed as an option if a man is elderly and his cancer is anticipated to grow very slowly, or if he has other medical conditions that may make treatment risky. It may also be discussed if it is unclear whether a treatment will help a man live longer.

In January 2010, a significant change was incorporated into the updated National Comprehensive Cancer Network (NCCN) Guidelines for Prostate Cancer. The NCCN guidelines suggest that men with low risk prostate cancer who have a life expectancy of less than 10 years should be offered and recommended active surveillance.

In addition, a new “very low risk” category was added to the updated NCCN Guidelines for clinically insignificant prostate cancer. The NCCN guidelines suggest that active surveillance is only offered and recommended for men in this category when their life expectancy is less than 20 years.

This "no treatment approach" is always a personal choice. Some men may decide they are not willing to accept the risk of side effects with current treatments for prostate cancer. The big unknown is that there is no guarantee that a man’s cancer will not become more significant over time—or even become untreatable.

A big decision

This is something that needs to be considered very carefully with your loved one’s entire medical team, so you both understand the potential pros and cons of this decision.

If your man decides to take this route, he will mostly likely have PSA testing and a digital rectal exam every few months. He may also need a biopsy every year. How often testing will occur may vary depending upon the doctor, as experts don't seem to agree on this.

If the results of these tests show any change—or your loved one develops troubling problems related to his cancer—his doctor will mostly likely discuss active treatment.

Always discuss everything you read on this web site with a qualified medical professional.

Updated 1/10



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