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February 13, 2023

Why Wait to Start Treatment for Prostate Cancer?

Why Wait to Start Treatment for Prostate Cancer?

If you’ve recently received a prostate cancer diagnosis and your doctor recommended waiting before starting treatment, you may be wondering why. For many patients, there are several reasons to wait. Let’s examine why waiting to receive prostate cancer treatment can be the best option and what that’s like.

Treatment Can Include Active Surveillance or Watchful Waiting for Prostate Cancer

Although prostate cancer is the most common type of cancer among men, after skin cancer, in almost all cases, it grows very slowly. When first diagnosed with prostate cancer, it’s given a grade called a Gleason score.

If the Gleason score is 6 or 3+4=7, the cancer is considered low-grade and likely to be slow growing. It also hasn’t spread to other areas of the body.

A score of 4+3=7 may require treatment sooner rather than later. And a Gleason score of 8, 9, or 10 will usually require treatment right away because it’s more likely to grow outside of the prostate.

If you have low-grade prostate cancer, your oncologist may suggest watchful waiting or active surveillance. This monitoring process includes a waiting period before beginning treatment.

Are Watchful Waiting and Active Surveillance the Same?

Although both involve waiting, the terms mean slightly different things and are recommended for different types of patients.

Active surveillance is usually recommended for patients who are expected to be cured when or if active treatment begins. It’s more often recommended for younger men because they have longer to live with prostate cancer, which increases their risk that it could reduce their future quality of life. They may believe active treatment's risks and side effects outweigh the hope for a cure. Or they may be uncomfortable waiting because it may limit their treatment options and limit the possibility of a cure.

Watchful waiting is recommended for patients who do not expect a cure but want to extend their life and control symptoms. Your oncologist will rely more heavily on treating the symptoms that are caused by prostate cancer and less energy on ordering tests to try to prep a medical team for operations or other direct treatment. Watchful waiting can prevent treatment that won’t extend life or have an impact on overall health.

What to Expect With Active Surveillance or Watchful Waiting

During active surveillance or watchful waiting for prostate cancer, you’ll have regular oncology appointments at least every six months. These visits can determine if:

  • You have symptoms causing discomfort

  • Your PSA level has changed

  • The tumor can be felt with a digital rectal exam

  • A biopsy result shows more abnormal cells

If you’re using active surveillance, your cancer will be monitored closely, including a PSA blood test twice a year and a digital rectal exam (DRE) annually. A biopsy and/or imaging tests will be done every year to three years. If any of these tests change, your oncologist will discuss active treatment options. The goal at that point will be to cure cancer.

With watchful waiting, you’ll have a repeat biopsy every three to four years. However, if the PSA increases significantly, the biopsy will be repeated to evaluate the next step in your treatment plan.

What Are the Benefits of Waiting to Start Prostate Cancer Treatment?

For men who have slow-growing prostate cancer, or those whose health would make it difficult to go through treatment, waiting makes it possible to maintain a high quality of life without symptoms or pain. The side effects of treatments and/or recovery from surgery can be difficult to manage for some men. For those who are not aiming for a cure, you can wait as long as possible. For those who would like to have prostate cancer cured, treatment can begin once it’s grown or symptoms are causing pain and the oncologist feels the treatment results outweigh the side effects.

If you have a prostate cancer diagnosis and you’re feeling anxious about waiting to start treatment, tell your oncologist. They can discuss options with you for treatment sooner.

What are Active Treatments for Prostate Cancer?

Active prostate cancer treatment begins because the cancer is progressing or because the patient is uncomfortable with having cancer and wants to be treated.

Radiation therapy is the first treatment often recommended, even before surgery. This is because the cancer can be treated with external beam radiation therapy and/or internal radiation therapy called brachytherapy without causing side effects caused by surgery.

Other treatment options that may be suggested include:

  • Hormone therapy - starves the cancer of the male hormones it needs to grow.

  • Surgery - radical prostatectomy is the most common surgery. It removes the prostate gland, seminal vesicles where semen is produced, and some surrounding tissue.

For advanced-stage metastatic prostate cancer, there are other treatments, such as

  • Targeted therapy

  • Immunotherapy

  • Chemotherapy

Treatments can come with side effects. The most common side effects include impotence and incontinence. Sometimes these are temporary and improve after treatments are completed. Talk to the oncologist about what side effects you might experience with the specific treatment recommended.

When is the Best Time to Begin Prostate Cancer Treatment?

If you’re being monitored with active surveillance, your oncologist will recommend active treatment for prostate cancer if your cancer is spreading or your Gleason score is increasing.

If you’ve chosen watchful waiting, active treatment can begin if the cancer becomes painful, is blocking your urinary tract, or you have other uncomfortable symptoms.

Your choice to undergo active surveillance, watchful waiting, or active treatment is a personal one. To make an informed decision that meets your personal preferences, be sure you understand all potential side effects, risks, and survival rates. You can read commonly asked questions from prostate cancer patients answered by the cancer doctors at Cancer Care Centers of Brevard.

Schedule a Prostate Cancer Consultation in Brevard County

Men who live in the Brevard County area can get expert prostate cancer evaluation and personalized treatment options at any of the Cancer Care Centers of Brevard clinics in Melbourne, Merritt Island, and Palm Bay, Florida. Find a location nearest you to request an appointment with a prostate cancer doctor.


Categories: Prostate Cancer