Throw us a bone

by Donna Canada, RN, CURN

Watchful waiting is a prostate cancer treatment option for men with a life expectancy of 10 years or less. It is the decision not to treat the prostate cancer at the time of diagnosis and is not aimed at curing the cancer, but rather to institute palliative treatment for local or metastatic disease progression if it occurs. Ideally, the patient and the physician identify a point at which therapy would be instituted (for example, a PSA value of a certain number or the presence of bone pain), and the patient is monitored without therapy until he changes his mind or that point is reached.

Watchful waiting differs from active surveillance in that with active surveillance one is followed more closely and the intent is to intervene while the prostate cancer may still be treated definitively.¹

Watchful waiting is ideally suited for patients with potentially life-threatening medical conditions and older patients with low Gleason scores. They will more likely die of something other than prostate cancer. Younger men (age less than 72 years), healthy men, and those with a higher Gleason score are more likely to live long enough to have symptoms and progression of disease in their lifetimes.

Advantages

• Eliminates morbidity, meaning unhealthy results, and complications of active treatment, such as erectile dysfunction (E.D) and urinary incontinence
• Risk of cancer progression with low grade, low stage tumor is low (10-25%) within ten years¹
• Rarely does low grade, low stage disease progress within five years

Disadvantages

• In men with nonmetastatic disease who survive more than ten years, 63% die of prostate cancer¹
• Younger men with initially confined disease have a higher risk of developing incurable disease and dying from it

 References:

1. Ellsworth P. 100 Questions & Answers About Prostate Cancer.2nd ed. Sudbury, MA: Jones and Bartlett Publishers; 2009.
2. American Cancer Society, Bostwick D, Crawford ED, Higano C, Roach M, eds. Complete Guide to Prostate Cancer.Atlanta, GA: ACS Health Promotions; 2005.
3. Walsh PC, Worthington JF. Dr Patrick Walsh's Guide to Surviving Prostate Cancer" 2nd ed. New York, NY: Wellness Central; 2007.
4. Scholz, M. Newly Diagnosed Prostate Cancer: Evaluating The Options -- Part 2 Of 3. CRI Insights [online] August 2003 vol. 6, no. 3, Available at: http://www.prostate-cancer.org/pcricms/node/141#ADT. Accessed on September 11, 2010.
5. Vogelzang, 2010 American Society of clinical Oncology Annual Meeting. August 2010 article: Cabazitaxel New Chemo Approved for Advanced Prostate Cancer. Available at: http://www.ustoo.org/PDFs/HotSheets/HotSheet082010.pdf . Accessed on September 11, 2010.
6. Warde, 2010 American Society of clinical Oncology Annual Meeting. July 2010 article: RT Shown Beneficial for Prostate Cancer Subset. Available at: http://www.ustoo.org/Hot_Sheets.asp. Accessed on September 11, 2010.
7. Crouzet, 2010 American Urological Association Annual Meeting Retrieved from July 2010 article: High Intensity Focused Ultrasound Noninferior to External Beam RT for Prostate Cancer. Available at: http://www.ustoo.org/Hot_Sheets.asp. Accessed on September 11, 2010.
8. MSNBC. FDA approves new drug for prostate cancer (press release). Available at: http://www.msnbc.msn.com/id/36853649/ns/health-cancer/. Accessed September 14, 2010.

This article has been reviewed by a member of the Wellness Partners Editorial Board.

Posted September 2010