- Prostate Cancer Treatment: Active Surveillance -
Watchful waiting is based on the premise that
localized prostate cancer may progress so slowly that they
are unlikely to cause some patients any
problems during their lifetimes. Some men who opt for watchful
waiting, also known as "observation" or "surveillance,"
have no active treatment unless symptoms appear or their PSA rises above a certain level. They are
asked to schedule regular blood draws and medical checkups and to
report any new symptoms to the doctor immediately.
Watchful waiting has the obvious advantage of sparing a
man with clinically localized cancer,who typically has no
symptoms, the discomforts, inconveniences, and risk of side effects of active treatment. On the down side, watchful waiting carries the risk of
closing the window of opportunity to control the cancer before it spreads. Another potential disadvantage
is the anxiety that comes from living with
untreated cancer.
The best candidates for watchful waiting are older
men whose tumors are small and slow-growing, as judged by
low PSA, Gleason grade less than or equal to six, and low stage.
Many men who choose watchful waiting live for years with
no signs of disease. Several studies have found that,
for at least 10 or even 15 years, the life expectancy of
men treated with watchful waiting (primarily older men with
less aggressive prostate cancer) is not substantially
different from the life expectancy of men treated with surgery
or radiation —-or, for that matter, of the population at large.
Follow-up for men on an active surveillance protocol includes regular check-ups including PSA and rectal exam. A common follow-up regimen includes a repeat prostate biopsy one year after the initial diagnosis.
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