Wait And See Or Treat Now?

I am often asked by newly diagnosed men and their partners if there is a difference between active surveillance (AS) and watchful waiting (WW). The answer is YES there are real differences even though they are often used interchangeably.

We have to take prostate cancer serious

While prostate cancer is common and the risk of dying is low, it remains the second leading cause of cancer death in men. It is not the so-called “good cancer” men often believe it to be. While a lot of humor is aimed at men and their fear over receiving the gloved finger tests, it is interesting to note that the same humor is not targeted at the second leading cause of cancer deaths in women (breast cancer) nor the leading cause of all cancer deaths (lung cancer). Watchful waiting and active surveillance are the more popular ways today to manage prostate cancer for men who are at low risk – typically a Gleason 6 score.

What is active surveillance?

So, what is active surveillance (AS)? Quite simply it involves monitoring a man’s prostate-specific antigen (PSA) levels for changes over a period of time. AS also involves having regular digital exams and by "digital" I do not mean via computer.

During a digital exam, your MD inserts a gloved finger into the rectum to feel. In my case, the urologist did detect a small lump that had been missed in an earlier examination. A PSA test measures the blood level of a protein produced by both noncancerous and cancerous tissue in the prostate. The higher a man’s level of PSA, the more likely it is a sign of cancer but not always. A larger prostate for example produces more PSA than a smaller one. And as men age, it is common for a prostate to increase in size. If that were not enough, certain activities like riding a bicycle or recent sexual activity can also cause a PSA score to spike.

Monitoring prostate cancer with active surveillance

If you are engaged in an AS protocol you will be visiting an MD ever 6 months for both a PSA test and a digital exam. Should your MD detect a rise in PSA or new growth your doctor will most likely suggest a prostate biopsy to see if the cancer has become more aggressive.

A typical biopsy involves taking 12 samples from different parts of the prostate. If the samples show a rise you and your doctor will have to decide to continue with active surveillance or move into treatment such as radiation, surgery, or hormonal treatment.

In addition to these options, there are several new treatments using other approaches. Take your time and ask lots of questions before moving ahead. Be sure you ask about the treatment, any potential side effects, and the success rate of each treatment option.

Emotional stress of active surveillance

The biggest downfall to AS is psychological due to the constant worry that something may be going wrong inside you. I have known several men who after being on this for a while and just decided it was too stressful and decided to go into treatment.

What is watchful waiting?

Watchful Waiting (WW) is different than AS and is often used when men are past the age of 70 and if their life expectancy is 10 years or less. Here the idea is to avoid PSA tests and digital exams and to avoid all treatment unless you get symptoms such as pain, extreme fatigue bone pain weight loss, or urine retention.

At any point, a man can decide to move to WW to AS and chose to be monitored more closely. The downside of WW is you may miss a chance to get earlier treatment and the longer you wait the process can be more difficult to endure and may also result in longer recovery times or not being able to be treated.

So, while AS and WW often sound similar they are quite different. Choose wisely.