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Active Surveillance and Watchful Waiting 

Both active surveillanceand watchful waiting are outpatient approaches allowing health care provider to monitor prostate cancer before medical intervention or therapy is used, if necessary. During the surveillance or waiting period, specific tests are performed regularly to detect any development of the disease. In the case of prostate cancer, watchful waiting may take several months or sometimes years, depending on the progress of the disease, before medical treatment is necessary.  Usually, men diagnosed with localized or very early prostate cancer and are eligible for active surveillance only treated if their cancer progresses. That is, a man can be on watchful waiting or active surveillance without ever receiving conventional treatment if the tumor remains localized.  

What is the difference between Active surveillance and watchful waiting?  

Neither active surveillance nor watchful waiting treat the prostate cancer; they only allow the health provider to see if the cancer progresses and spreads to other organs. In case the tumor does not spread or cause symptoms, watchful waiting is considered instead of treating the cancer with medical intervention. Active surveillance is the decision to postpone the therapy – surgery or radiation - until the cancer begin to progress or change to more serious characteristic. This approach is important to avoid as long as possible side effects related to the treatment.  Various studies have shown that appropriate selection of patients is important for the success of active surveillance. In general, active surveillance is offered to men having low risk, localized prostate cancer. 

Who are candidate for watchful waiting?  

The watchful waiting is usually recommended to a specific group of patients: men who are at the end of their sixty or older, men who are suffering from prostate cancer at low risk, or men who have a serious health problem that increases the risk of death during the treatment. During the watchful waiting, regular appointments are necessary to perform tests in order to monitor the cancer. Medical test that are often performed include Meta-Analysis of Prostate-Specific Antigen and Digital Rectal Examination

Who are candidate for active surveillance?  

Active surveillance is mainly recommended to men having very low-grade stage of prostate cancer . This option is also considered in case of: 

  • life expectancy of 20 years or more 
  • the cancer is diagnosed at stage T1a 
  • Gleason score of 6 or less 
  • PSA levels below 10 ng / mL 
  • low density of the PSA 
  • less than three biopsies have revealed the cancer 
  • Cancer in less than 50% of each sample.  

 

If your doctor recommends you active surveillance, he will regularly perform specific tests and exams to monitor progress of the tumor within the prostate gland. Diagnostic procedures that often performed include:

  • Digital (finger) rectal examination 
  • Analysis of Prostate-Specific Antigen 
  • Prostate biopsy every 6 to 18 months  
  • And sometimes other tests depending on the results of the above tests.  

Benefits and risks of active surveillance   

 

Benefits 

Risks 

  • Maintain normal sexual ability 
  • Avoidance of unnecessary treatment 
  • Maintaining the quality of life and functional capacity 
  • Avoidance of complications  or side effects of the therapy: radiotherapy or surgery 

 

  • Decreased chance of healing 
  • Risk of progression or spread of cancer before treatment 
  • Difficult of late treatment and  increased risk of side effects  
  • Delaying surgery can reduce the chances of preserving sexual ability 
  • Anxiety of knowing that the cancer is not treated 
  • Need of regular follow-up examinations and biopsies of the prostate from time to time
  • Imaging techniques may not be able to detect the development or spread of cancer