Prostate Cancer: Watchful Waiting vs. Active Surveillance

Categories: Cancer Treatment, Prostate Cancer

September 9, 2019

Prostate cancer is one of the most common types of cancer in men. Most of the men who have it are over 65 and live active lives. If your oncologist (the type of doctor that sees cancer patients) sees that your cancer is growing slowly, they may decide that you don't need treatment. You should never make that decision by yourself. 

If you were diagnosed with prostate cancer, you may hear your oncologist use terms such as "watchful waiting" or "active surveillance." These may come up if the cancer is determined to be small, slow-growing, and confined within the prostate (has not metastasized). Some doctors don't use the terms properly, so be sure that your oncologist has the right definition.

As their names imply, they're two completely different methods. So then, what are they and what makes them different from each other?

What Is Watchful Waiting for Prostate Cancer?

If your prostate cancer has yet to show symptoms or is just small, then your doctor may suggest watchful waiting. The goal of this method is to monitor the tumor and avoid treatment until it's necessary. It's a hands-off approach, meaning that it won't require that many tests. Especially when compared to the frequent tests that come with active surveillance. 

The idea of waiting around for symptoms to show may not sit right with you. That's fine. The decision is ultimately yours. However, there are benefits to watchful waiting. Treatments for prostate cancer involve radiation, chemotherapy, and surgery. They're all procedures that could be taxing on your body. That's why it's usually better to wait and see if you'll need them.

Certain types of prostate cancer will grow quickly. That makes this approach unsuitable for them. Your oncologist will let you know if that's the case.

Pros and Cons of Watchful Waiting for Prostate Cancer

The following are the advantages of watchfully waiting for your prostate cancer to metastasize:

  • You won't have to undergo treatments and regular tests for prostate cancer. 
  • You won't have to endure the side effects of treatment.
  • Symptoms may never show up. You may never have to be treated.
  • If symptoms do manifest, you and your oncologist can then create a prostate cancer treatment plan.

The following are the disadvantages of watchful waiting:

  • The tumor won't be actively monitored, so it may grow sooner than expected.
  • You may feel anxiety over the uncertainty of your condition.

What Is Active Surveillance for Prostate Cancer?

Active surveillance is the process of carefully monitoring prostate cancer for any signs of emerging symptoms. It's typically used for low-risk prostate cancer that's still in the early stages. Your doctor usually won't suggest active surveillance if you're young. 

In the event that your oncologist chooses to use active surveillance, they'll use regular tests to monitor the tumor. Doctor's appointments will be scheduled every 3 to 6 months. During these visits, you will most likely undergo one or more diagnostic test such as: prostate-specific antigen (PSA) tests, digital rectal examinations, MRI scans, and biopsies.

Pros and Cons of Active Surveillance for Prostate Cancer

The following are the advantages of active surveillance for prostate cancer:

  • You don't need to undergo surgery or chemotherapy until symptoms manifest.
  • You and your doctor will be updated regularly on the growth of your prostate cancer. 
  • Once symptoms manifest, a treatment plan will be developed. There are many different options for prostate cancer treatment.

The following are the disadvantages of active surveillance:

  • Regular appointments may interfere with your life or annoy you.
  • Repeat tests may make you uncomfortable.

Which One Is Right for Me?

Both watchful waiting and active surveillance are perfectly fine options, but you can only choose one at a time. The decision is up to you and your doctor. This can lead to a better quality-of-life, and for some, may never result in prostate cancer treatment. Pick whichever option makes you and your family more comfortable.

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