The prostate is a gland present in men’s bodies, located below the bladder and in front of the rectum. The size of the prostate changes throughout men’s lives and is responsible for the formation of a fluid that protects and nourishes sperm cells in semen, making the semen more liquid. Prostate cancer occurs when the cells in the gland start to grow out of control, the reasons for which are not fully understood. However, DNA alterations are known to contribute to the development of prostate cancer. Some prostate cancers may grow and spread faster than others, causing different symptoms on both the urinary and reproductive systems.
Symptoms of the disease include problems passing urine, including a slow or weak urinary stream or the need to urinate more often, especially at night, blood in the urine, erectile dysfunction, pain in the hips, back, chest, or other areas from cancer that has spread to bones, weakness or numbness in the legs or feet, or even loss of bladder or bowel control from cancer pressing on the spinal cord. There are numerous treatment options for patients who suffer from prostate cancer, recommended according to the patients’ age and expected life span, other severe health conditions, cancer stage and grade, physician’s and patient’s opinions on treatment and possible side effects, as well as likelihood that each type of treatment has to cure the cancer.
What Is Watchful Waiting for Patients with Prostate Cancer?
In some patients, particularly older men or men with other severe health problems, prostate cancer develops and progresses slowly. In these cases, physicians may prefer to wait before treatment or not to treat them at all. “Instead, their doctors may recommend approaches known as expectant management, watchful waiting, observation, or active surveillance,” explains the American Cancer Society. “Some doctors use these terms to mean the same thing. For other doctors the terms active surveillance and watchful waiting mean something slightly different.”
Active surveillance refers to a close monitoring of the cancer growth through prostate-specific antigen (PSA) blood tests, digital rectal exams (DREs), and ultrasounds at regular intervals. Watchful waiting or observation, on the other hand, consists on a less intensive type of follow-up including less tests and more based on the patient’s symptoms. “Not all doctors agree with these definitions or use them exactly this way. In fact, some doctors prefer to no longer use the term watchful waiting. They feel it implies that nothing is being done, when in fact a man is still being closely monitored. No matter which term your doctor uses, it’s very important to understand exactly what he or she means when they refer to it.”
When Is Watchful Waiting an Effective Prostate Cancer Approach?
The use of watchful waiting is particularly indicated in cases when the prostate cancer is not yet causing symptoms, it is expected to grow slowly according to its Gleason score, and / or when the tumor is small and has not yet spread outside the prostate. While the disease is not being cured, patients do not experience the risks and side effects associated with other treatment options like radiation or surgery. Some researchers and investigators believe that in some cases the benefits of more aggressive treatment options are lower than its consequences.
However, “some men are not comfortable with this approach, and are willing to accept the possible side effects of active treatments to try to remove or destroy the cancer,” explain the American Cancer Society. “Not all experts agree how often testing should be done during active surveillance. There is also debate about when is the best time to start treatment if things change. (…) So far there have been no large studies comparing active surveillance to treatments such as surgery or radiation therapy. Some early studies of men who are good candidates for active surveillance have shown that only about a quarter of the men need to go on to treatment with radiation or surgery.”
Note: Prostate Cancer News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.