The concept of active surveillance or watchful waiting, has increasingly emerged as a viable option for men, who, for one reason or another, have decided not to undergo immediate curative treatment such as cryoablation, surgery or radiation therapy.
Prostate cancer is a disease with a long natural history and it has been shown that prostate cancer diagnosed in its early stages will generally not spread or cause harm for several years. Although the argument has been that this option is just postponing treatment, it is an excellent option for men who have very slow growing, or early stage cancers. Curative treatment usually involves some level of risk, trading possible sexual or urinary quality of life for the longer-term assurance that prostate cancer will not progress and cause pain or death. When considering these trade offs, immediate treatment might not be preferred by some men. Instead, they might opt for vigilant monitoring with frequent PSA (prostate specific antigen) and DRE (digital rectal exam) and subsequent prostate biopsies to monitor the aggressiveness of the cancer. In addition, imaging such ultrasound, CT scans, bone scans or MRI might be used to watch for disease growth and the need for treatment.
Several recent studies have shown that men who are older than 75 as well as those who have small, low-grade tumors at diagnosis might do well with this approach.
Overall health is an important consideration. Men who have other serious medical conditions such as heart disease, high blood pressure or poorly controlled diabetes and would tolerate chemotherapy and radiation poorly, might be good candidates for active surveillance.
Are you a good candidate for active surveillance? This can only be determined after you have considered the risks and benefits of all of the options available. This is generally accomplished by a detailed consultation, exam and discussion with your physician.