“Watchful Waiting”
Also known as “observation” or “surveillance”, watchful waiting, as the name implies, is a treatment regime typically comprised of regularly-scheduled appointment focused on observing the progress of a patient with typically symptom-free, localized, slow-moving prostate cancer. The most obvious candidates for watchful waiting are older men whose tumors are small and slow-growing, as judged by low grade Gleason score and low stage.
This treatment is based on the premise that cases of localized prostate cancers may advance so slowly that they are unlikely to cause men—especially older men—any problems during their lifetimes. Some men who opt for watchful waiting have no active treatment unless symptoms appear. In addition to regularly-scheduled medical checkups, patients undergoing watchful waiting are asked to immediately report any new symptoms.
Watchful waiting has the obvious advantage of sparing a man with such cancer the pain and possible side effects of surgery or radiation. However this type of deferred treatment presents the risk of decreasing the chance to control disease before it spreads; and of potentially postponing treatment to an age when chemotherapy and radiation may be more difficult to tolerate.
Another potential disadvantage to watchful waiting is the anxiety experienced by some men who don't want to live with an untreated cancer possibly advancing within their systems.
Many men who choose watchful waiting live for years with no signs of disease. A number of studies have found that, for at least 10 or even 15 years, the life expectancy of men treated with watchful waiting (primarily older men with less lethal forms of prostate cancer) is not substantially different from the life expectancy of men treated with surgery or radiation - or, for that matter, of the population at large.
My Take
In deciding to pursue watchful waiting as a treatment modality, you should be comfortable with two elements: The first is your doctor’s rationale for not pursuing other treatment options; and the second is the periods between visits in your reexamination schedule. If you are not satisfied with either of these elements, you might want to seek a second opinion.