Therapeutic Dilemmas in Prostate Cancer: Justification for Watchful Waiting

Is ‘watchful waiting’ a real choice for men with prostate cancer? A qualitative study

“…Patients who choose watchful waiting need the support of their doctors and families, particularly if members of self‐help groups do not support them. If possible, with the patient's permission, relatives should also be included in discussions about treatment options, so that they also understand that watchful waiting is an active process [4], and that other treatments can be started later if necessary. If family members do not understand the rationale behind watchful waiting they may put immense pressure on men to seek other more aggressive active treatments, which may not be in the best interests of the patient.…”

“…Watchful waiting, also termed active surveillance or monitoring, implies no therapy once the disease has been diagnosed until the patient has some symptom resulting from complications of local or systemic disease [3]. However, when considering watchful waiting the patient should be reassured that his progress will be monitored, and that any necessary treatment will be carried out in good time [4].…”

“…Many urologists consider that watchful waiting is an inappropriate choice for younger men with early‐stage prostate cancer [6]. For example, George [4] stated that watchful waiting is ‘certainly not suitable for any patient aged less than 65 years with disease curable by radical therapy, unless the patient has limited life expectancy for any other reason’, and when British consultant urologists were asked about treatment preferences, radical treatments were the first choice of treatment for all hypothetical patients with apparently localized disease under the age of 70 years [7].…”

The management of localized prostate cancer

“…17 While this option avoids the adverse effects associated with therapy of curative intent, this approach may place patients at a greater risk of disease progression. Indeed, approximately 50% of men enrolled in the Cancer of the Prostate Strategic Urological Research Endeavour (CaPSURE) who elected watchful waiting required initiation of treatment within 5 y of diagnosis.…”

Image-Guided Prostate Cryosurgery: State of the Art

“…With some recent studies showing minimal survival benefit between no treatment and RP, the concept of "watchful waiting," ie, not treating the primary tumor at all, has gained acceptance by some as a viable management alternative in certain patient populations. 4 The decision to treat prostate cancer with a particular ther- -Transrectal ultrasound showing the ice as it extends toward the rectum. The freezing front (FF) is exquisitely seen as a hyperechoic (white) line extending toward the rectum (R).…”