Watchful Waiting

Watchful waiting, also known as expectant management, involves monitoring prostate cancer but not necessarily treating it. Watchful waiting is considered in men whose prostate cancer is not causing any symptoms, for elderly or infirmed patients, and for younger patient with nonaggressive, slow-growing tumors. In some men, especially older ones, prostate cancer can grow very slowly and may never need treatment. Instead, their doctor may track the patients’ PSA levels and conduct digital rectal exams (DREs) at regular time intervals. If their PSA levels should rise relatively quickly or symptoms of prostate cancer begin to appear, treatment may be recommended.

It is not yet known whether invasive treatments including surgery and radiation therapy increase the chances of survival more so than watchful waiting in men with slow-growing cancer. Therefore, many doctors find watchful waiting an attractive option for some of their patients. It should be noted too that the risks and side effects associated with some treatments outweigh their benefits.

Advantages of watchful waiting

1. Allows for a high quality of life
2. Excellent 10- to 15-year survival rate in patients over 65
3. Comparable to the 5- to 10-year survival rate of external beam radiation therapy or surgery in older patients with localized, nonaggressive disease.

Disadvantages of watchful waiting

• Prostate cancer tends to progress so use is limited in patients younger than 645.
• The optimal time to begin intervention or to stop watching and waiting have not yet been determined.