Watchful Waiting for Prostate Cancer

Marc Greenstein Health Guide
  • There are many options to treat prostate cancer. These include radical surgery, seed implantation (brachytherapy), external beam radiation therapy, cryosurgery and hormonal therapy.


    Another option is watchful waiting. It is important to understand that watchful waiting is not a curative treatment. It is recognizing that a man has prostate cancer and the patient is going to have the cancer closely monitored by his Urologist.


    As we know, the majority of prostate cancers are slow growing and take years before they grow outside the prostate gland. Even after it has spread to other organs, such as the lymph nodes and bone, it can take a few more years before the man will die from prostate cancer. Watchful waiting can be a good management option for the appropriate individual.

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    I would not recommend it to a patient with a Gleason score of 7 or higher, nor would I recommend it for a patient with a PSA greater than 10.0 ng/ml. It is not recommended for a man younger than 65 years of age. Watchful waiting should not be used if a man is expected to live another ten or fifteen years at the time of their diagnosis. 


    Watchful waiting can be used for men with low volume disease. For example, a prostate biopsy revealed a small percentage of prostate cancer in only one biopsy core. A man's age can also determine the aggressiveness of their treatment. A 79 year old man can be monitored whereas a 59 year old should be treated. In addition, a man's co-morbid factors are crucial when deciding on a treatment option. For example, a 73 year old man with advanced diabetes and 3 previous heart attacks can consider watchful waiting.


    There are no standard regimens for watchful waiting. Once a man is diagnosed with prostate cancer confined to the gland (it has not spread) and they choose watchful waiting, they should have a PSA every 3 months.


    A repeat prostate biopsy should be considered 12 to 18 months later to see if the tumor size is growing. A more aggressive form of treatment should be initiated if the PSA slowly rises or a repeat biopsy shows a larger volume of cancer.


    Since there is no "one size fits all" treatment, each man must learn as much as he can about various treatment options and, collaboratively with his physician, make his own decision about what is best for him.

Published On: May 23, 2007