Watchful Waiting for Prostate Cancer

Depending on your prostate cancer diagnosis, watchful waiting could be the right plan for you. Watchful waiting is a less-intensive management strategy for prostate cancer which can help those who are too old or too sick to go through with more aggressive treatment.

You and your doctor will rely solely on monitoring your symptom progression, rather than the results of regular tests. In this way, watchful waiting is less stressful than active surveillance.

Basically, the goal is to use a hands-off approach towards treating prostate cancer. Your doctor will only begin to intervene if the disease is causing you pain or severely disrupting your quality of life (e.g. being too painful to urinate). The logic behind this is to limit unnecessary exposure to the side effects and pain associated with intense monitoring or further treatment.

Within the medical world, there is an on-going transition to move towards reducing aggressive treatment for slow-growing prostate cancer when appropriate, to minimize unnecessary overtreatment and testing.

Whether watchful waiting or active surveillance is better for you will depend on how aggressive your cancer is and your life expectancy (based on your age and other ailments). According to guidelines from the US National Comprehensive Cancer Network (NCCN), active surveillance should be considered for those who are facing low-risk prostate cancer and have a life expectancy of 10 years or more. On the other hand, watchful waiting can be recommended for those with a life expectancy of lower than 10 years.

If you are considering watchful waiting for prostate cancer, but are not quite sure if it’s the right option for you — here are some questions you can consider or discuss with your doctor:

• Based on your age and other potential health issues, are you expected to live for over ten years?

If the answer to this question is yes, watchful waiting may not be right for you. There is a higher chance of you developing aggressive cancer symptoms over a longer period of time.

• When it comes to enjoying your life, what is important to you? Are you okay with repeating tests every few months or years?

If you prefer the safety of regular testing, active surveillance may be the better option for you, depending on your current status. However, if you have been undergoing active surveillance for a while, but have not seen any progression — you may want to consider watchful waiting.

• Are you able to accept doing nothing for now, despite knowing that your cancer might still advance one day?

While having fewer tests may improve your quality of life and reduce disruptions to your lifestyle, you may still start to feel some anxiety about unknowingly missing some progression. However, if you are okay with this compromise, then watchful waiting may be right for you.

Ultimately, while these are good questions to think about — the final decision you and your doctor feel most comfortable making will depend on your life expectancy, current health status and personal preferences.