Why Wait to Start Prostate Cancer Treatment?

Receiving a diagnosis for prostate cancer brings with it a lot of questions. Some people suggest waiting, others suggest you have surgery to remove the prostate. What’s the right path for you and why would anyone want to put off treatment for cancer? Let’s look further at why some people wait to receive prostate cancer treatment and what the waiting process looks like.

Prostate Cancer Can be Slow Growing

Although prostate cancer is one of the most common types of cancer, it’s rare for a man to die of prostate cancer because it usually grows slowly. As long as it’s identified, it can be monitored and then treated at the right time. That’s why prostate cancer screening is so important. Your doctor will periodically check to see if there are signs that prostate cancer is developing. If signs point to the possibility of prostate cancer, a biopsy will be done to see how the cells look. This produces a Gleason score.

A Gleason score will give the doctor a sense of how much change there is in the prostate cells. Anything under a score of 6 is usually considered cancer-free. A Gleason score of 6 is low-grade cancer; 7 is medium-grade; 8 to 10 is high.

Based on the Gleason score from a biopsy, the oncologist may recommend simply waiting and watching to see if the cancer starts to grow further.

Because many prostate cancers grow slowly and cause no symptoms or problems, many men can delay cancer treatment.

Prostate Cancer Treatment Can Include Watchful Waiting or Active Surveillance

Standard treatment options for prostate cancer include surgery, radiation, hormone or targeted therapy, chemotherapy, immunotherapy, and bisphosphonate therapy. However, they can cause side effects, including sexual problems (inability to get and maintain an erection), incontinence (inability to control urine or bowel movements), infection, and pain.

These treatments are recommended when the oncologist believes they will extend the patient’s life or relieve symptoms.

Monitored observation is better for men who have:

• No symptoms

• A small tumor confined to the prostate gland

• A slow-growing tumor

• A low PSA level

For these men, either the effects of the treatment would have a negative impact on their quality of life, or the cancer is simply not far enough along to warrant treatment.

Is watchful waiting the same as active surveillance?

In some ways, yes. Both of these approaches use a wait-and-see tactic. However, the goal of active surveillance is to delay treatment for patients who are expected to be cured if/when treatment begins. Watchful waiting is meant to extend the life of a patient, without expecting it to be cured.

What to Expect if You’re Using Watchful Waiting or Active Surveillance for Prostate Cancer

Periodic appointments with your urologist or oncologist are booked about every 6 months. The goal of each check-in is to determine if there are signs of the cancer growing, and to check on the patient’s symptoms to see if they’re starting to be uncomfortable. The doctor will likely check PSA levels, perform a digital rectal exam to see if they can feel the tumor, and possibly repeat a prostate biopsy to look for changes. Also, the doctor will ask about any changes in symptoms. Additionally, a new prostate biopsy will be requested. The timing between biopsies depends on whether you’re under active surveillance where the cancer can be cured, or if you’re under watchful waiting where the goal is mostly to relieve symptoms and extend the patient’s life. These can be every year for active surveillance or every 3-4 years if you’re on watchful waiting.

Be sure to tell the doctor at your check-up if you’re experiencing any symptoms or anything out of the ordinary for you. This will help them in making treatment recommendations that are best for you.

When is the Right Time to Start Prostate Cancer Treatment?

If test results show signs of the cancer spreading, or the Gleason score is getting higher, there is a good chance it may be time for those on active surveillance to start treatment. For those who are on watchful waiting treatment is usually started when the cancer is causing pain or blocking the urinary tract. Your oncologist will discuss the need to start a medical treatment and which ones they recommend based on your specific situation.

With either watchful waiting or active surveillance, it’s important to understand why your oncologist recommends treatment and the potential side effects, risks, and survival rates before making a treatment decision. Ultimately, the choice is a personal decision that each man should make after consulting with his oncologist.

If you have fast-growing prostate cancer, cancer has spread beyond the prostate, or you have a strong preference for removing the cancer, active surveillance or watchful waiting may not be the best treatment option for you.

If you’ve received a prostate cancer diagnosis and live in the South Chicago suburbs, consider a consultation with one of Affiliated Oncologists’ prostate cancer specialists. Treatments, when needed, can be done very close to your home. Request an appointment or a second opinion at a location near you.

Categories: Prostate Cancer