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When is Watchful Waiting Appropriate for Prostate Cancer Patients?

For some older patients with prostate cancer, active treatment isn’t always the best option for their health. Instead, watchful waiting could be the right choice.

Prostate cancer is the most common type of solid organ cancer diagnosed in men and those assigned male at birth in the United States. While prostate cancer can be successfully treated when diagnosed early, it can also be slow-growing and does not always need to be actively treated if it is low risk and not causing serious harm to the patient.

Because of this, some patients may choose not to get their cancer treated right away. Instead, they may opt for one particular strategy not often discussed, which is called watchful waiting.

Watchful waiting isn’t appropriate for all patients. It’s important to talk to your doctor and understand the different options for prostate cancer management. At Jefferson Health, urologists Dr. Patrick T. Gomella, and Dr. James Ryan Mark help patients decide the right path for them.

Understanding prostate cancer management options

Active treatment, active surveillance and watchful waiting are three strategies used to manage localized prostate cancer. The individual approach usually depends on the aggressiveness of the cancer and the overall health and age of a person with this diagnosis. Active treatment of localized prostate cancer involves surgery or radiation, sometimes in combination with hormone therapy, with the goal of removing the tumor and preventing it from recurring.

Active surveillance is a treatment strategy for low- and certain intermediate-risk patients during which the cancer is followed closely with routine biopsies, blood tests and imaging. “With active surveillance, the goal is for selected patients to avoid or delay the side effects of prostate cancer treatment, while still keeping a close eye out if the cancer becomes more aggressive,” says Dr. Gomella. “If that occurs, patients can begin active treatment at that time while still maintaining a good chance of curing the cancer.”

Like active surveillance, watchful waiting aims to avoid the side effects of active treatment; however, because the patient is not likely to experience any complications from their cancer, the goal is to intervene only to limit symptoms of the disease, rather than cure it. “This is a prostate cancer management strategy typical for older patients with other serious health conditions who need to avoid the toxicity of cancer treatment,” says Dr. Mark.

Knowing the difference between watchful waiting and active surveillance

There are key differences between active surveillance and watchful waiting. “Patients undergoing active surveillance have a different experience compared to patients pursuing watchful waiting,” says Dr. Gomella. “The goal of active surveillance is to watch the cancer’s progression with the intent of treating it in the future, if necessary. These patients will be under close surveillance by their doctor and will undergo frequent testing.”

“It is vital for those who are recommended treatment with active surveillance to understand that while it may initially seem like the cancer is going untreated, the goal is still to cure the cancer if there is any indication that it might progress to more serious disease,” says Dr. Mark.

The purpose of watchful waiting, on the other hand, is to make sure a patient is comfortable and can sustain their quality of life without the toxicity of cancer treatment. Those who are undergoing watchful waiting are not typically subjected to further invasive testing and are asked to monitor for any symptoms that may develop in the future which can suggest the cancer is progressing.

If a patient experiences symptoms that become bothersome or affect their quality of life, they can have a discussion with their primary care provider to determine if they should start any treatments for those symptoms. Symptoms of advancing prostate cancer include difficulty urinating, changes in bowel habits, pelvic pain, weight loss and bone pain.

Deciding if watchful waiting is right for you

After a cancer diagnosis, a patient and their doctor may decide to proceed with watchful waiting for a number of reasons. The patient might have a competing diagnosis that is more serious, like heart disease. Perhaps active treatment for cancer would be too hard on the body and the patient’s quality of life would suffer. Or maybe their life expectancy is less than 10 years and they’re unlikely to receive any benefit from prostate cancer treatment.

“Watchful waiting is the least common form of cancer management; however, it is still a valid option. Since there is no goal for actively treating the cancer unless symptoms develop, it usually requires a difficult discussion with the patient and their family,” says Dr. Gomella.

Dr. Mark advises patients to be open with their healthcare team about their concerns and desires. “Your doctor can be a helpful consultant, leading you down a decision path that fits your life and lifestyle goals,” he explains. “At Jefferson, we have experts and multidisciplinary specialists in many different fields that can help you navigate your diagnosis or treatment.”

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