As doctors detect prostate cancer at earlier stages, active surveillance and watchful waiting are becoming viable treatment options for an increasing number of men. Both are methods of monitoring your condition for any changes so you and your doctor can decide whether another treatment becomes necessary.
What Are These Approaches?
With active surveillance, your doctor closely monitors your cancer using prostate-specific antigen (PSA) tests, digital rectal exams, ultrasounds, and biopsies at regular intervals, as appropriate. If there is a change in your results that indicates your cancer is becoming more aggressive, your doctor will talk with you about your treatment options.
Watchful waiting involves less testing—rather, you and your doctor monitor any changes in your symptoms to determine if you need treatment.
Who Is a Candidate?
Your doctor may suggest active surveillance or watchful waiting if your cancer is not causing any symptoms, is slow growing, or is small and confined to the prostate.
Age is not a primary factor in recommending these approaches. But prostate cancer can take ten or more years to spread enough to become life threatening, so if you already have a life expectancy of less than 10 years, it might not make sense to undergo aggressive cancer treatment, and your doctor might suggest this course of treatment. Active surveillance or watchful waiting might also be appropriate if you prefer not to undergo aggressive treatment, if you want to avoid side effects of more aggressive treatment, or if you have health problems that prevent you from being a candidate for other types of treatment.
Some doctors use the terms “active surveillance” and “watchful waiting” interchangeably. If you and your doctor decide on one of these approaches, be sure you understand and agree with the course of action your doctor recommends.
If you are uncomfortable with active surveillance or watchful waiting, or if you choose this approach and experience stress from not having treatment for your prostate cancer, discuss your feelings with your doctor.
Clinical Study at SCCA
Active surveillance and watchful waiting have had excellent long-term results in patients with low-risk, localized prostate cancer. The challenge is determining which prostate cancer patients will benefit most from active surveillance or watchful waiting and which patients may benefit from immediate treatment. A clinical study nicknamed PASS (Prostate Active Surveillance Study), led at Seattle Cancer Care Alliance by Daniel W. Lin, MD, is ongoing to find biomarkers that will identify tumor aggressiveness. This may help doctors determine at the time of diagnosis which patients can safely delay or avoid treatment and which will benefit from treatment.