Prostate Cancer - Watchful Waiting

Watchful Waiting

Because not all prostate cancers will progress to threaten patients' lives, M. D. Anderson does consider watchful waiting as a treatment option for very carefully selected patients with low-grade prostate cancer. These patients fall into two general categories:

Patients who believe the side effects of treatment (impotence, urinary incontinence) are excessive.Watchful waiting would be considered for these men if they:

• Recognize there is no validated screening method for early detection of disease progression
• Have a low Gleason score
• Have low-volume disease
• Have a PSA level within the normal range (or accounted for by an enlarged prostate)
• Are willing to submit to follow-up with annual biopsies and quarterly PSA tests

Patients in whom the risk for cancer is less than the risk from unrelated, co-existing health conditions.Watchful waiting would be considered acceptable if:

• Patients have a less than 10-year expected survival
• The Gleason score is low
• Patients have low-volume disease
• The PSA level is within the normal range
• Patients have an estimated survival of less than 5 years and a cancer judged not to be at risk during that time
• Patients are willing to submit to follow-up with quarterly PSA tests and annual biopsies

The challenge of watchful waiting is that oncologists still cannot anticipate progression of the disease in a timely enough fashion to avoid risky treatment delays, and there are still no reliable methods to select patients in whom cancer is unlikely to spread. As the ability to predict prostate cancer progression improves, the risks of watchful waiting can be minimized.