Treatment

Watchful Waiting

Watchful waiting, also called expectant therapy, deferred therapy, or observation, is a course of action in which no immediate active treatment is taken. Instead, the cancer is carefully observed and monitored regularly. If a man develops bothersome symptoms or his cancer begins to grow more quickly, decisions about active treatment can be reconsidered.

Both watchful waiting and active intervention carry their own risks. Untreated prostate cancer will continue to grow, but may take years until symptoms become problematic. Since prostate cancer is most frequently diagnosed in older men and often grows slowly over a long period of time, many question whether any treatment is actually necessary. Many men who have prostate cancer are never affected during their lifetime. However, some untreated cancers can grow quickly, spread, cause symptoms and ultimately kill. Even small, slow-growing tumors may become rapidly-growing tumors if given enough time.

A large study sponsored by the National Cancer Institute and the Veterans Affairs Cooperative Studies Program is looking into how active treatment affects survival and quality of life of prostate cancer patients of different ages. The PIVOT (Prostatic Intervention versus Observation Trial) is still in progress and data will not be available for many years.

Appropriate candidates for watchful waiting

• Men who are elderly and without any prostate cancer symptoms. Because prostate cancer often spreads very slowly, many older men who have the disease never need any treatment.
  
  
• Men who are frail or have other serious health problems and will be unable to withstand treatment or its side effects.
  
  
• Men who believe the side effects of aggressive treatments outweigh their benefits.
  
  
• Older men (70 and over) whose cancer is very small, contained in one area of the prostate, moderately to well differentiated and expected to grow very slowly.
  
  
• Men whose expected lifespan is less than 10 years.
  
  
• Men whose prostate cancer is too advanced for hope of curative therapy.

Those who should consider other treatments

• Healthy men with a life expectancy of greater than 10 years. If left to grow long enough, even small cancers can become potentially dangerous, spread and kill.

Benefits of watchful waiting

• Short- or long-term freedom from treatment side effects.
  
  
• No treatment-associated expenses, although monitoring expenses are incurred for regular PSA blood tests and digital rectal examinations.
  
  
• If monitoring indicates the cancer is growing very slowly, treatment may be delayed indefinitely.

Risks of watchful waiting

The obvious risk is that if left untreated, even small cancers will grow and spread. If you live long enough, you may be faced with an advanced and rapidly growing cancer. In addition, some cancers that appear to be small and slow-growing are in reality larger and more aggressive.

Monitoring progress

For men who may later opt for treatment, monitoring commonly includes a PSA blood test and digital rectal examination every six months and, possibly, a repeat transrectal ultrasound and biopsy. If PSA levels begin to climb or if your physician notes changes in the DRE, additional testing will be required to determine if the cancer is growing.

The Prostate Cancer pages of this Web site are part of the Comprehensive Prostate Cancer Awareness Program (CPCAP), a major regional effort to reduce the rates of death and illness caused by prostate cancer in southwestern Pennsylvania. Funding for CPCAP is provided by a grant from the Commonwealth of Pennsylvania.

Return to top of page