What is watchful waiting?

Watchful waiting (also called expectant therapy or active surveillance) is a strategy to actively "watch and wait" while carefully observing and monitoring the prostate cancer. It is becoming more common to refer to this strategy as active surveillance. This approach may be recommended by your physician if your prostate cancer is in a very early stage, especially in the cases of older men with small tumors that are:

• expected to grow very slowly.
• confined to one area of the prostate.
• not causing any symptoms or other medical problems.

Because prostate cancer cells often spread very slowly, many older men who have the disease may not need more extensive treatment. However, expectant therapy usually includes routine physician examinations, including digital rectal examinations (DRE) and prostate-specific antigen (PSA) tests.

The National Comprehensive Cancer Network (NCCN) defines active surveillance as  "actively monitoring the course of disease with the expectation to intervene if the cancer progresses."

NCCN guidelines recommend active surveillance as an option for patients with low risk of recurrence. Patients with a low risk are defined as:

• having a stage T1 to T2a tumor
• having a Gleason score 6 or below
• having a PSA level below 10 ng/mL

Patients with a "very low risk" (which is a new designation for the NCCN) are listed as:

• having a stage T1a tumor
• having a Gleason score of 6 or below
• having a PSA level below 10 ng/mL
• having fewer than 3 positive biopsy cores (with <50% cancer in each)
• having a PSA density below 0.15 ng/mL per gram.

For men with a low risk for recurrence and less than 10 years of life expectancy, the recommended monitoring for disease progression is the same as for very-low-risk men with less than 20 years of life expectancy.

In each case, the NCCN calls for:

• PSA testing as often as every 6 months
• digital rectal exam as often as every 12 months.
• Following a required initial needle biopsy, subsequent biopsy is optional and can be repeated within 18 months, especially if there were 10 or more cores initially. The biopsy can be repeated within 6 months if there were fewer than 10 cores initially.
• For low-risk men with more than 10 years of life expectancy, a repeat biopsy is required — it is not optional — as often as every 12 months.

National Comprehensive Cancer Network offers an informative online webinar discussing the new 2010 NCCN practice guidelines for active surveillance in cases of localized, non-aggressive prostate cancer . This webinar is geared for professionals but presented in an easy to understand format. The webinar is free but you must register. (Simply click "other" when asked for medical specialty during the registration process.)  

Learn More >>  Making the Treatment Decision Informational Seminars are offered monthly to provide clear, unbiased information on the treatment options available for prostate cancer. It is our goal to help you make the best treatment decision for you and your family.

Prostate cancer patients must be actively involved in choosing between several equally effective treatment methods. Patients should be encouraged to research the various options and make their decision taking into account their quality of life concerns along with their work and home life schedules. Although a diagnosis of cancer can be an intimidating experience, the more you are informed about the options available to you, the more equipped you will be to make the decision that is best for you.

We encourage you to contact our Patient Navigator at (678) 843-5665 or rsevy@sjha.org with any questions regarding watchful waiting or other treatment options for prostate cancer at Saint Joseph's. We're here to help.

Information on this page is provided collaboratively by the team at the Prostate Cancer Center at Saint Joseph's and has been medically reviewed by Rajesh G. Laungani, MD, 2010. Claims regarding treatment are based on years of clinical experience and industry reported data. The PCC follows American Urological Association and  National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for the treatment of prostate cancer.

Last Updated: October 14, 2010 (RSH)