Active Surveillance and Watchful
Both active surveillanceand
watchful waiting are outpatient approaches allowing health
care provider to monitor prostate cancer before medical intervention or therapy is used, if necessary. During
the surveillance or waiting period, specific tests are
performed regularly to detect any development of the disease.
In the case of prostate cancer, watchful waiting may take several months or sometimes years, depending on the
progress of the disease, before medical treatment is necessary. Usually, men diagnosed with localized or
very early prostate cancer and are eligible for active
surveillance only treated if their cancer progresses. That is, a man can be on watchful waiting or active surveillance without ever receiving
conventional treatment if the tumor remains localized.
What is the difference between Active surveillance and watchful waiting?
Neither active surveillance nor watchful waiting treat the prostate cancer; they only allow the health provider to
see if the cancer progresses and spreads to other organs. In case the tumor does not spread or cause symptoms,
watchful waiting is considered instead of treating the cancer with medical intervention. Active surveillance is the
decision to postpone the therapy – surgery or radiation - until the cancer begin to progress or change to more
serious characteristic. This approach is important to avoid as long as possible side effects related to the
treatment. Various studies have shown that appropriate selection of
patients is important for the success of active surveillance. In general, active surveillance is offered to men
having low risk, localized prostate cancer.
Who are candidate for watchful
watchful waiting is usually recommended to a specific group of patients: men who are at the end of their sixty
or older, men who are suffering from prostate cancer at low risk, or men who have a serious health problem that
increases the risk of death during the treatment.
During the watchful waiting, regular appointments are necessary to perform tests in order to monitor the cancer.
Medical test that are often performed include Meta-Analysis of
Prostate-Specific Antigen and Digital Rectal Examination
Who are candidate for active surveillance?
Active surveillance is mainly recommended to men having very low-grade stage of prostate
. This option is also considered in case of:
expectancy of 20 years or more
cancer is diagnosed at stage T1a
score of 6 or less
levels below 10 ng / mL
density of the PSA
than three biopsies have revealed the cancer
in less than 50% of each sample.
If your doctor recommends you active surveillance, he will regularly perform specific tests and exams to monitor
progress of the tumor within the prostate gland. Diagnostic procedures that often performed include:
- Digital (finger)
- Analysis of
biopsy every 6 to 18 months
sometimes other tests depending on the results of the above tests.
risks of active surveillance
Maintain normal sexual ability
Avoidance of unnecessary treatment
Maintaining the quality of life and functional capacity
Avoidance of complications
or side effects of the therapy: radiotherapy or
Decreased chance of healing
Risk of progression or spread of cancer before treatment
Difficult of late treatment and increased risk of
Delaying surgery can reduce the chances of preserving sexual ability
Anxiety of knowing that the cancer is not treated
Need of regular follow-up examinations and biopsies of the prostate from time to
Imaging techniques may not be able to detect the development or spread of