Prostate Cancer
Watchful waiting and active surveillance for prostate cancer
Some prostate cancers are very slow growing and never cause the man any problem. This is particularly true with older men, many of whom will die from another condition before the cancer causes trouble. Because there is also considerable uncertainty about the effects of all of the available treatments for prostate cancer, 'watchful waiting', which involves frequent monitoring without active treatment, may be the best choice for some men.
Watchful waiting
Watchful waiting aims to avoid treatment unless symptoms develop. If a man does chose watchful waiting, active treatment may be pursued if symptoms become apparent or the cancer progresses and starts to grow. You will have regular PSA tests and may have digital rectal examinations.
Some men were certain that watchful waiting was not an option they could have lived with. Also, not all men were aware that watchful waiting is considered to be a serious option for men with prostate cancer, perhaps because it is hard to believe that early aggressive treatment would not be most beneficial. One man's doctor told him that watchful waiting was not recommended for men of African descent.
Concludes he could not have lived with watchful waiting.
Concludes he could not have lived with watchful waiting.
No I don't think I could've handled it. It's a bit like,well I've got to get rid of it, no I don't think I would,because you'd be walking, you'd be walking around thinking well it's still there. In fact you still do now but not to that extent because you feel somebody has done something for you, well you know somebody has done something for you but no I don't think I could've lived with that.
Compares watchful waiting to naive ignorance.
Compares watchful waiting to naive ignorance.
Did the surgeon ever give you the option of doing nothing?
I suppose we could've said we'd rather bury our head in the sands. I think he would've given us, he was the sort of chap who'd have given us a monumental lecture and quite rightly if we had decided that we just couldn't face it [a radical prostatectomy], and if I was may be you know terribly scared of theatres or whatever I don't know. Luckily we were both absolutely in agreement that we wanted to get on with it, but no I think he would have given us a severe ticking off if we'd prevaricated and he would've told us.
Men who wanted to opt for watchful waiting could come under considerable pressure from well-meaning members of their families, support groups or doctors, and commented that you might need to be quite strong to stick to the decision.
Highlights the pressure from his consultant and wife to not continue with watchful waiting.
Highlights the pressure from his consultant and wife to not continue with watchful waiting.
I was very upset in London when the biopsy was done because the consultant said 'I operate on you right away.' Now I had read up things meanwhile and I was terrified of either incontinence or well lack of sex.
I saw this consultant who had done this biopsy, under whose direction it was done, in fact he had directed himself and he was insistent that he would operate on me and I was really upset. He said 'I've done 400 of these and only 10% go wrong,' [laughs] and I said 'Yes but I, I don't want to be 1 of the 10%.'
My wife kept pestering me in a very nice way that I should think about it and my children, well they live in different countries apart from one in London, one in Scotland and the others are phoning me up every month and saying 'How is it going dad?' even 2 years later and it's very sweet but I don't really appreciate that very much.
For men who chose watchful waiting the deciding factors were finding out about the uncertainty of benefits from active treatment; and avoiding the incontinence and impotence which are frequent side effects of treatment (see the 'Side effects of treatments' section). For at least one man the disruption involved in daily radiotherapy treatment was also a factor. Those who had chosen watchful waiting had sought second opinions, spoken to doctors in the family and had seen a US video reviewing treatment options.
Concludes his decision to opt for watchful waiting stems from the uncertainty of benefits in active treatment.
Concludes his decision to opt for watchful waiting stems from the uncertainty of benefits in active treatment.
I have read articles which describe the state of play of research and treatment into prostate cancer and I sort of now know that in terms of western medicine pretty much what is known in the sort of professional fraternity on prostate cancer. And I suppose my decision to adopt watchful waiting, for the time being at least, is based on the scientific evidence that really the doctors don't actually know whether the outcomes of their different treatments are more positive if you like in terms of well I suppose the overall satisfaction and results for the patient. So that's weighing up the chances of eliminating the cancer with the side effects that I mentioned earlier of impotence and urine dysfunction and indeed it can also induce some bowel dysfunction as well, depending on the treatment that you've undergone. And in addition to that the rates of success in terms of eliminating the cancer are also not absolutely clear using different treatments. I'll give an example, there is apparently in the United States a surgeon who has stated that 30% of his patients after operation he has realised he probably would've been better not to have operated on, in other words he's actually found even though he's been very careful only to operate on patients he thought would have a good chance of success in 30% of the cases it would probably have been better not to operate, in other words the side effects are probably more significant than the disease itself and indeed it's not necessarily had an impact on eliminating the disease, presumably may be because it's spread somewhat.
Active surveillance
Active surveillance is another form of observation for men with localised prostate cancer. In this case the doctor intends a man to have treatment to try and cure the cancer if it starts to grow. It is different from traditional watchful waiting in that the patient is more carefully observed. In the first year of surveillance you will usually have blood tests every 3-4 months to monitor your PSA levels and digital rectal examinations every 6 months, and will be asked if you have developed any new symptoms and after a year you will be asked to have a prostate biopsy. After the first year of surveillance you will usually have blood test every 3-6 months to monitor your PSA levels and a digital rectal examination every 6 months. After five years of surveillance blood test will usually be every 6 months and a digital rectal examination every 12 months (recommended by NICE CG175 January 2014).
If these regular tests show that the cancer is progressing (growing) your doctors will then recommend treatment intended to cure the cancer, such as surgery or radiotherapy. If your cancer is not growing or developing, it is safe to continue with active surveillance.
Last reviewed July 2017.
Last updated March 2015.
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