Watchful Waiting for Prostate Cancer – When is it Safe?

prostate cancer

Most doctors will use terms as ‘active surveillance’ and ‘watchful waiting after a patient gets diagnosed with prostate cancer. Watchful waiting indicates delaying treatment until symptoms show growth of cancer or some changes. This period involves patients to go through fewer tests. They are also required to get follow-ups.

An active surveillance will involve regular scheduled monitoring of cancer by doctors. Patients go through a lot of tests and biopsies. Watchful waiting should be in line with doctor’s consent and suggestion. You should also consider your physical and mental well being. It is better to start a treatment if the cancer starts affecting your daily life or adds stress and makes you emotionally weak.

Candidates for Watchful Waiting

Watchful waiting is suggested for men with early-stage prostate cancer. The cancer grows slow. Men older than 65 years of age or with serious health problems are also good candidates. It is not known if surgery or radiation therapy can help them live longer. As per studies and research, men of different cancer stages and ages are given different set of instructions.

Active surveillance can also be suggested for smaller, slow-growing tumors. Prostate cancer surgeons may start off with the treatment when test results indicate a change in the tumor.

The goal of watchful waiting or active surveillance is to avoid side effects of prostate cancer surgery and follow-up treatments. Waiting to start a treatment procedure may be risky as it reduces your ability to control the disease when it becomes aggressive. It can also limit treatment options in future.

Waiting for treatment will depend on the following:

– Your Gleason score

– Size of tumor

– Location

Doctors will suggest waiting only if the tumor is small and restricted to the prostate.

Tests During Watchful Waiting/Active Surveillance

Doctors suggest getting regular check-ups for signs and symptoms indicating change in the tumor. Patients are suggested to go through diagnostic tests. These include:Prostate-Specific Antigen (PSA) Blood Test

The test measures the amount of PSA in blood. PSA level under 4 Nanograms per milliliter of blood is healthy. Men with this PSA level may have prostate cancer.  Enlarged prostate may also raise PSA levels. Doctors compare recent results of PSA test with previous one.

Digital Rectal Exam (DRE)

It is a quick test where doctor feels for any hard areas or bumps on the prostate indicating growth of cancer. A DRE will also determine if the tumor has spread outside the prostate.

Repeat Biopsy for Prostate Cancer

Repeat biopsies for prostate cancer are performed a year after diagnosis. It is performed every 4-5 years after the initial biopsy. The process involves use of a thin, hollow needle to remove tissue samples from your prostate. Doctors may give local anesthetic for this procedure. The samples are sent to lab for testing. The cells are tested by a pathologist to determine Gleason score. The doctor compares the score with previous scores.

Doctor may suggest additional treatments when they observe the following:

– A rise in Gleason score

– Increase in PSA level

Treatment options are also recommended when you develop any or some of the symptoms list below:

– Blood in the urine

– Loss of bowel/bladder control

– Pain in chest, back, hips or other areas

– Problems passing urine

– Numbness/weakness in feet and legs

– Trouble getting an erection

Test Schedule As per a suggestion by the National Cancer Institute, patients should go for tests every 3-6 months initially. A repeated biopsy should also be done to reassess Gleason score after 12 months. It is important to let your doctor know if you develop any symptoms or notice certain changes between checkups.

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