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Watch And Wait Prostate Cancer

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Observation Or Active Surveillance For Prostate Cancer

Prostate Cancer | “Watch and Wait” Approach vs. Treatment

Because prostate cancer often grows very slowly, some men who have it might never need treatment. Instead, their doctors may recommend observation or active surveillance.

The terms active surveillance and observation mean something slightly different:

  • Active surveillance is often used to mean monitoring the cancer closely. Usually this includes a doctor visit with a prostate-specific antigen blood test about every 6 months and a digital rectal exam at least once a year. Prostate biopsies and imaging tests may be done every 1 to 3 years as well. If your test results change, your doctor would then talk to you about treatment options to try and cure the cancer.
  • Observation is sometimes used to describe a less intensive type of follow-up that may mean fewer tests and relying more on changes in a mans symptoms to decide if treatment is needed. This treatment is most often meant to control symptoms from the cancer, but not to cure it.

No matter which term your doctor uses, its very important for you to understand exactly what they mean when they refer to it.

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Surgical procedures to remove the diseased prostate are usually necessary. Surgical procedures are not always necessary. If the disease is caused by bacterial infections, a doctor can treat the symptoms using alpha-blockers or surgery. Physical therapy, relaxation exercises, and warm baths are all recommended. A physician may also prescribe antibiotics to cure the infection. A bacterial infection can also cause a recurrence of the condition.

An enlarged prostate can be uncomfortable for both men and women. Some of the symptoms of an enlarged male reproductive organ include a weakened urine stream, urgent need to urinate, and urinary tract infections. BPH can also cause damage to the kidneys. A sudden inability to urinate can be life-threatening, as it can lead to bladder and kidney damage. Unfortunately, most men with enlarged prostrates put up with the symptoms for years before they seek treatment. However, many of the men with symptoms finally decide to go to a doctor for proper gynecological evaluation and to begin enlarged prostatic therapy.

When Is Watchful Waiting Safe For Prostate Cancer

After getting a prostate cancer diagnosis, ‘watchful waiting’ and ‘active surveillance’ are clinical terms you may hear from your doctor. Watchful waiting for prostate cancer means delaying treatment until you have symptoms or there are other signs the cancer is growing or changing in some way. Watchful waiting involves fewer tests and follow-up than active surveillance, which involves regularly scheduled monitoring of cancer with tests and biopsies .

Keep in mind that prostate cancer specialists are not in consensus when it comes to the definition of watchful waiting and active surveillance. Some doctors see them as one form of clinical management of the disease and do not differentiate between the two, and some doctors do not use the terms. When discussing your diagnosis and plan going forward, make sure you are on the same page with your doctorthat you understand what your doctor means by watchful waiting or active surveillance and you agree with the plan.

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Good Candidates For Watchful Waiting And Active Surveillance

Watchful waiting is a reasonable approach for men with early-stage prostate cancer that seems to be slow growing, especially for men who are older than 65 or have other serious health problems. For these men, its not known whether surgery or radiation therapy will help them live longer. However, more research studies are necessary, comparing men of different ages and stages of cancer.

Active surveillance is also an option for small, slow-growing tumors. Treatment would begin if test results indicate a change in the tumor, or if you develop bothersome symptoms.

Both watchful waiting and active surveillance allow you to delay or avoid the side effects of surgery, radiation therapy, or other treatments. But it can be risky. Waiting to start treatment means that you may have less of a chance to control the disease if it becomes more aggressive. Waiting could also limit your treatment options.

Whether watchful waiting and active surveillance are safe options for you depends on these two main factors:

  • Your Gleason score, which is the result of a lab test that analyzes the pattern of prostate cancer cells. The pattern determines the tumors likeliness to spread.
  • Your tumor size and location, which you learn from the stage of prostate cancer. If its small and contained within the prostate, you may be a good candidate for waiting.

Does My Age Influence Whether Active Surveillance Is The Right Choice For Me

How Does Prostate Cancer Spread?

Younger men will live longer with their cancers, and thus have a higher likelihood that their cancer could progress. However, younger men whose cancers appear to be less aggressive may be able to stay on Active Surveillance longer. Younger men also have more to lose when it comes to quality of life as they often have better erectile and urinary function than older men.

Active Surveillance may also be more appropriate for men who are currently battling other serious disorders or diseasessuch as significant heart disease, long- standing high blood pressure, or poorly controlled diabetes. In a patient with other health issues, the patient and his doctors might feel that performing invasive tests or treatment would cause more harm than benefit. For these men, their treatment plan would of course help manage any symptoms that occur due to advanced disease. There are also some men with favorable intermediate risk who may be good candidates for Active Surveillance.

Some physicians also administer commercial genetic testssuch as Decipher®, ProMark®, and Prolaris®that may be helpful in determining if you are a good candidate for Active Surveillance. Researchers are working to define the best ways to use these tests.

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Active Surveillance Watchful Waiting What Every Man With Prostate Cancer Should Know

Oleksandr N. Kryvenko, MD, FCAP, is Assistant Professor of Pathology and Urology at the Sylvester Comprehensive Cancer Center, University of Miami Health System, in Miami, FL.

Theres a member of your health care team who plays a vital role in your diagnosis and cancer care who you may never meet face to face: the pathologist. This is the doctor who analyzes the sample of tissue removed during a biopsy to make the correct diagnosis.

As a pathologist specializing in prostate cancer, I know that any cancer diagnosis is alarming. Men diagnosed with prostate cancer may be even more alarmed if active surveillance and watchful waiting come up. Their very names sound like the opposite of what should be done in cancer treatment. But understanding these 2 approachesand their differencescan help you make informed decisions as you consider prostate cancer treatment plans.

Observation Or Active Surveillance Vs Treatment

A few large studies have compared observation and surgery for early-stage prostate cancer, but the evidence from these studies has been mixed. Some have found that men who have surgery might live longer, while others have not found a difference in survival.

So far, a few studies have compared active surveillance to treatments such as surgery or radiation therapy. Men who undergo surgery or radiation do not appear to live longer than those that undergo active surveillance, but their cancer might stay away longer and spread less.

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Bekelman JE, Rumble RB, Chen RC, Pisansky TM, Finelli A, Feifer A,et al. Clinically Localized Prostate Cancer: ASCO Clinical Practice Guideline Endorsement of an American Urological Association/American Society for Radiation Oncology/Society of Urologic Oncology Guideline. J Clin Oncol. 2018 32: 3251-3258.

Chen RC, Rumble RB, Loblaw DA, Finelli A, Ehdaie B, Cooperberg MR, et al. Active Surveillance for the Management of Localized Prostate Cancer : American Society of Clinical Oncology Clinical Practice Guideline Endorsement. J Clin Oncol. 2016 Jun 20 34:2182-90. doi: 10.1200/JCO.2015.65.7759. Epub 2016 Feb 16.

Last Revised: August 1, 2019

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The Difference Between Watchful Waiting And Active Surveillance

Watchful waiting is often confused with active surveillance, which is another way of monitoring prostate cancer. The aim of both is to avoid having unnecessary treatment, but the reasons for having them are different. Check with your doctor which one you’re being offered.

Watchful waiting

  • If you do have treatment at any point, it will usually aim to control the cancer and manage any symptoms rather than cure it.
  • Its generally suitable for men with other health problems who may not benefit from treatment such as surgery or radiotherapy, or whose cancer may never cause problems during their lifetime.
  • It usually involves fewer tests than active surveillance. These check-ups usually take place at the GP surgery rather than at the hospital.

Active surveillance

  • If you need treatment at any point, it will usually aim to cure the cancer.
  • It is only suitable for men with slow-growing cancer that hasn’t spread outside the prostate , and who would benefit from treatment such as surgery or radiotherapy if they needed it.
  • It usually involves more regular hospital tests than watchful waiting, such as magnetic resonance imaging scans and prostate biopsies.

Other names you might hear

Some people use names such as active monitoring, deferred therapy, watch and wait, and wait and see to describe both watchful waiting and active surveillance. These can mean different things to different people, so ask your doctor or nurse to explain exactly what they mean.

What Does Watchful Waiting Involve

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If youre on watchful waiting you will have tests to monitor your cancer. You wont have any treatment unless you get symptoms.

Youll normally have a prostate specific antigen blood test at your GP surgery or hospital clinic every 6 to 12 months. This will help to check for any changes to your prostate cancer.

You might also have digital rectal examinations and other blood tests. You probably wont need to have regular scans or prostate biopsies.

If any changes are picked up by these tests or you have any new or different symptoms, you may be given an appointment with the doctor or nurse at the hospital.

What symptoms should I look out for?

You should let your GP or doctor or nurse at the hospital know if you notice any symptoms or changes to your health. Things to look out for include:

  • any changes to your urinary habits, for example needing to urinate more often, especially at night
  • problems urinating such as a weak or slow flow
  • blood in your urine
  • unexplained weight loss
  • new swelling in your legs.

Ask your doctor or nurse if there are any other symptoms or changes to your health that you should look out for, as well as who to contact about them.

What happens if I get symptoms?

If you start to notice any of these symptoms you might need more tests to see if your cancer has spread, and you may be offered treatment.

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Prostate Cancer: Watch And Wait Or Ignore And Wait

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A long-term European study highlighted key patient compliance issues in the prostate cancer active surveillance strategy. In lieu of proactive prostate cancer treatments such as robotic prostate surgery, hormone therapy, or radiation, some men choose to postpone treatment and monitor the progression of their disease. Researchers found that one quarter of European men who chose to watch and wait failed to comply with follow-up testing, a critical component to long-term success, according to experts.

David B. Samadi, MD, Chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital, perceives this pitfall as a major risk factor for prostate cancer survival. Active surveillance and watchful waiting are only viable options if patients understand the critical nature of screening compliance, said Dr. Samadi. So many men with prostate cancer are symptom-free and without frequent exams we have no way of preventing the disease from spreading.

Active surveillance involves undergoing regularly scheduled prostate-specific antigen blood tests, digital rectal exam physicals, and prostate biopsies and ultrasounds. As reported at the European Association of Urology annual meeting in Stockholm, 27 percent of active surveillance study participants abandoned their screening plans over the 13-year review period. Even at just three months post-diagnosis, 19 percent of the men refused to undergo a second prostate biopsy.

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Symptomatic treatment of an enlarged prostate usually involves a combination of medication and lifestyle changes. A diet rich in fruits and vegetables may be the best option if you suffer from chronic urination. It will help the body adjust to the increased size of the prostate. Also, taking regular urination intervals will help retrain the bladder to function properly. Inactivity also contributes to urine retention, and cold temperatures can increase the urge to urinate.

Invasive treatment of enlarged prostate includes medication that relieves the pressure on the urethra and bladder. However, if the condition is severe, it may require surgical intervention. If treatment is not successful, the enlarged prostate can become a potentially life-threatening disease. As the hormone levels in the body change, the enlarged prostate can lead to various complications, including urinary retention and even cancer. This is why it is critical to see a doctor for further evaluation.

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Prostate Cancer: Watchful Waiting Vs Active Surveillance

About one out of every eight men will be diagnosed with prostate cancer during his lifetime, making it the second most common cancer in American men, behind only skin cancer.1 However, due to advances in cancer screening awareness and early detection, most men will not die from prostate cancer. In fact, many men who are diagnosed with an early-stage, low-grade cancer may need little to no immediate medical treatment. Instead, they can choose from two different methods of monitoring their prostate cancer: watchful waiting or active surveillance.

For men with prostate cancer, the goal of cancer management methods like watchful waiting and active surveillance is to avoid the side effects caused by cancer treatments like surgery or radiation therapy.

Both watchful waiting and active surveillance are ways of monitoring the cancer for changes, but the reasons for choosing one method over the other are different:

  • Watchful waiting is better for men who cant undergo curative treatment. It is meant to manage symptoms by controlling the cancer, but is not intended to cure it.
  • Active surveillance is better for men who would benefit from curative treatment should the cancer become more aggressive.

Prostate cancer patients may wish to forgo immediate treatment, and instead use watchful waiting or active surveillance when:

The Initial Causes Watch And Wait Prostate Cancer

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One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.

Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.

If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.

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What You Need To Know About The Prostate Watch And Wait Prostate Cancer

A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.

While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.

Tests To Expect During Watchful Waiting And Active Surveillance

Although watchful waiting implies that nothing will be medically done until necessary, your doctor will still check you regularly for signs and symptoms of a change in the tumor, such as difficulty urinating.. You may have some diagnostic tests, but they will be less invasive and less frequent compared to active surveillance. These are the tests you will have:

Prostate-Specific Antigen Blood Test:

This test measures the amount of PSA in your blood. Both normal and cancer cells in the prostate make PSA. A PSA level of less than 4 nanograms per milliliter of blood is considered healthy. Although men with a PSA lower than 4 can have prostate cancer, generally cancer develops when the PSA goes higher than 4.

Other conditions besides prostate cancer, such as an enlarged prostate, can raise PSA levels. During watchful waiting and active surveillance, your doctor will compare your most recent PSA test result with your previous one.

Digital Rectal Exam :

During this quick test, a doctor feels for bumps or hard areas on the prostate, which may indicate prostate cancer is growing. A DRE can also determine whether the tumor has grown outside the prostate.

Your doctor may suggest treatment if your Gleason score rises, your PSA level begins to increase, or you develop symptoms. These may include:

  • Blood in the urine

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