The New England Journal of Medicine recently published the results of a landmark Scandinavian study that showed men who undergo radical surgery upon diagnosis are less likely to die from their disease than those men whose condition is addressed with “watchful waiting.”
The problem, experts note, is the men in the study, which was conducted in partnership with the Harvard School of Public Health, who were part of the watchful waiting group did not receive any treatment designed to cure their prostate cancer, regardless of how their cancer progressed. In essence, the researchers proved surgical treatment for prostate cancer is more effective than no treatment at all, but they did not account for the fact a prostatectomy may not be the best first course of action in all patients.
What Does “Watchful Waiting” Really Mean?
When you were a child and came down with a fever, chances are your parents called the pediatrician, who most likely recommended keeping an eye on your temperature and any other symptoms. If things changed dramatically, the pediatrician recommended your parents then schedule an appointment. In the meantime, your parents would most likely be directed to keep you comfortable and take steps to reduce your fever as much as possible.
The same general principle applies in “watchful waiting” in prostate cancer. Rather than immediately scheduling surgery, which comes with certain risks, patients who have smaller or less aggressive tumors may wait to seek treatment. Prostate cancer tends to develop slowly; if it is not progressing rapidly, the patient has time to consider all treatment options.
Watchful waiting does not mean a patient receives a cancer diagnosis and is sent on his way only to return a year later for a checkup. Some doctors refer to watchful waiting as “active surveillance,” in which the patient undergoes regular exams, blood tests to check PSA levels and biopsies to gauge the progression of the cancer and determine an appropriate course of action. If things change drastically, it’s time to take more aggressive action.
Watchful Waiting Is Not for Everyone
The idea of “watchful waiting” as a plan for prostate cancer isn’t right for everyone. In general, it’s best for patients who have few or no symptoms, a small tumor that is confined to the prostate or expected to grow slowly. If the cancer is fast growing or has already spread, or if the patient is younger (i.e., under age 30) then more aggressive, immediate treatment is usually the best option. Only you and your health care provider can determine the best course of action for your situation.
One of the benefits of watchful waiting is it allows you the chance to explore your treatment options and choose the one that works best for you. We recommend talking with your specialist at the Pasadena CyberKnife Center and scheduling consultations with various treatment providers to learn the risks and benefits of all treatment options, including surgery and radiation. Depending on your case, one method may be more effective than another, and you need to arm yourself with as much information as possible to make the best decision for yourself and your health.