— "Watchful Waiting"
Watchful waiting is based on the premise that cases of
localized prostate cancers may advance so slowly that they
are unlikely to cause men—especially older men—any
problems during their lifetimes. Some men who opt for watchful
waiting, also known as "observation" or "surveillance,"
have no active treatment unless symptoms appear. They are
often asked to schedule regular medical checkups and to
report any new symptoms to the doctor immediately.
Watchful waiting has the obvious advantage of sparing a
man with clinically localized cancer,who typically has no
symptoms, the pain and possible side effects of surgery
or radiation. On the minus side, watchful waiting risks
decreasing the chance to control disease before it spreads,
or postponing treatment to an age when it may be more difficult
to tolerate. Of course, treatments may also improve over
time if watchful waiting is chosen. Another potential disadvantage
is anxiety; some men don't want the worry of living with
an untreated cancer.
The most obvious candidates for watchful waiting are older
men whose tumors are small and slow-growing, as judged by
low grade Gleason score and low stage.
Many men who choose watchful waiting live for years with
no signs of disease. A number of studies have found that,
for at least 10 or even 15 years, the life expectancy of
men treated with watchful waiting (primarily older men with
less lethal forms of prostate cancer) is not substantially
different from the life expectancy of men treated with surgery
or radiatio—-or, for that matter, of the population