Prostate Cancer: Is Waiting an Option?

The truth about “watchful waiting”…and why do they call it that?

A 78-year-old man with heart disease and a few other problems was found to have a prostate cancer. Not a bad one, not a large one. Just an average run-of-the-mill prostate cancer. One that, chances are, will not kill him.

In fact, for many men who are older and may not be healthy, some prostate cancers will not be the cause of their passing (as I get older I think passing sounds better than death). I am sure if you have read enough you realize that most men diagnosed with prostate cancer do not die of it, they die with it.

Cardiovascular deaths are still the biggest killer of men. When talking to patients I like to bring up an old saying “If I do my job right, you won’t die of prostate cancer, even if you still have it with you.”

So who needs their prostate removed, radiation, hormone therapy or chemotherapy? Who gets to go home and do nothing but check a PSA and prostate exam a few times each year? This is the big question all urologists would like to answer.

In general, it comes down to this — if it is felt that the prostate cancer will be significant in your expected lifetime, then it is a good idea to have it taken care of. There are almost 50,000 men who die of prostate cancer each year.

With that in mind, and taking into account the different aspects of the cancer and the individual, there are some instances where it is believed that doing nothing may be the best approach. There are some instances where we feel that any or all the treatments will be more hazardous than the cancer, or that the odds are good the patient will die of other causes before the cancer can become a problem.

So if you choose this non-treatment we used to call watchful waiting, what does that mean? First of all, watchful waiting is not a good phrase as it implies we are waiting for something to happen. What is better is “expectant management” of a known prostate cancer.

Expectant management with curative intent, also called active surveillance, is the new way of looking at this prostate cancer option. Older men with smaller volumes of non-aggressive cancer can be watched very closely with PSA blood tests and exams.

The plan is to initiate curative treatments, such as surgery or radiation, if and when changes occur to suggest cancer growth and progression. This will allow many men that qualify to avoid the potential side effects of treatments, and limiting aggressive therapy to those men that truly need it. The key is patient selection — to identify and select only those men who can benefit from expectant management and do not need treatment right away.

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