It may be surprising for you to learn that not all men with prostate cancer require treatment right away. And some men may never need to receive prostate cancer treatment.
When we evaluate you for prostate cancer, we will place you into one of two groups.
Patients with actively growing prostate cancer requiring treatment, or
Patients whose cancer can be closely monitored without treatment for a period of time. In the medical community, this is referred to as watchful waiting or active surveillance.
If you are told that your particular diagnosis would benefit from watchful waiting or active surveillance, this does not mean that we do nothing. Instead, it indicates that we should postpone treatment until a later time.
Some men are uncomfortable with a waiting period. If you are nervous about not taking action, we can create a prostate cancer treatment plan that is most appropriate for you considering your overall health, age, and gleason score.
Men with low-risk cancer are the best candidates for watchful waiting or active surveillance. This group is defined as patients with a Gleason score of 3+3=6, or as otherwise recommended by your doctor. Additionally, the cancer stage is a critical component in determining who should be considered for watchful waiting. Cancer is grouped into three types of cancer, with four different main stages, and subcategories under each. The first letter in the cancer stage is either T (Tumor), M (Metastasis), and N (Node). Then comes the stage of cancer. There are four different cancer stages, and these are given numerical values from 1-4. The stages refer to the location and potential for spread throughout the body. Stage 1 cancer is generally slow-growing, while stage 4 can be considered more aggressive. Finally, the final value is related to the size, spread, and appearance of cancer cells. These subcategories are broken into alphabetized ranges from A-C. Patients who have a stage T1C or T2A are also likely candidates for active surveillance. Very low-risk patients are those with this same criteria and also meet the following criteria:
No more than two needles with cancer out of the standard 12-needle biopsy
The cancer in any one needle can be no more than half of that needle.
If you fall into this category, your doctor will likely suggest watchful waiting rather than an immediate cancer treatment plan.
Watchful waiting is started for those given a lower Gleason score after a prostate biopsy has been completed. During a watchful waiting period, your primary care physician or urologist will work closely with you to identify the best schedule for prostate cancer tests that might include a PSA test more frequently than usual, or other tests that will help your physicians understand if the cancer has started growing.
Typically this means having a PSA blood test every six months.
The PSA checks are continued every six months. Additionally, either a 12-needle or MRI fusion, one year later, no matter the PSA levels' outcome. Another prostate biopsy is done 2-4 years later. However, if the PSA starts to rise significantly, the prostate biopsy is repeated no matter what the length of time has been since the first biopsy. If the cancer gets worse, then a treatment plan is created.
While many men develop prostate cancer, most do not die from it because it can be very slow growing. Watchful waiting is put in place to prevent men from undergoing cancer treatments to eliminate cancer that will likely not have severe impacts on a man’s overall health during his lifetime.
Depending on your age and your overall health, some of the side effects of treatment can be significant, including urinary incontinence (leaking urine) or becoming sexually impotent. By waiting to start treatment if the cancer isn’t growing quickly, possible treatment side effects can be delayed or avoided.
The chances of your cancer progressing during watchful waiting is a common concern that you may have. This particular subject is still being studied, but based on the information we have, about 30-40% of men will undergo treatment within ten years following their prostate cancer diagnosis. This is typical because the cancer progresses or the patient gets too nervous and wants to be treated. While it is possible, it is very uncommon for patients to die from issues related to prostate cancer during watchful waiting. The concept here is that you and your primary care physician or urologist closely monitor the cancer and create adjustments to your care as needed.
Unfortunately, there is a lack of long-term research for watchful waiting. There are no long-term studies for men in the very low-risk group. However, we have 10-year data for observing patients who participate in watchful waiting that showcases the success of this type of approach to prostate cancer observation.
Speak with a Prostate Cancer Nurse Navigator who can answer your questions and assist with setting up a consultation with a radiation oncologist for a second opinion.