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Active Surveillance (Watchful Waiting)

During active surveillance, or watchful waiting, no active medical treatment is provided. Active surveillance is generally considered for elderly men (>70 years old) with low grade (Gleason 6) prostate cancer and a low PSA (<10 ng/mL). These men may have an indolent disease. This means that although they have prostate cancer, it would remain dormant for the remainder of the patient’s life. Since prostate cancer is usually a slow growing tumor, the likelihood that such a man will ever die or be affected by the disease is low. As such, routine PSA tests and yearly biopsies are required to assess for cancer Gleason upgrading or a rapid PSA rise. If this were to occur, suggesting cancer progression, other definitive therapy would be required.

Many such men will live out their normal life spans without treatment and without the cancer spreading or causing other problems. But watchful waiting can also be a rational option for a younger man as long as you know the facts, are willing to be vigilant, and accept the risk of a tumor spreading during the observation period, rendering your cancer incurable.

Eligible men should meet the following criteria:

  • Older age — usually men in their 60s or those with other health problems.
  • Cancer cannot be felt on digital rectal examination (referred to as stage T1c).
  • PSA appropriate for prostate size meaning that the PSA density (PSA divided by ultrasound determined prostate volume) is 0.1 or less.
  • Combined Gleason grade or score is 6 or less and no more than 2 biopsy cores contain cancer.
  • Cores containing cancer should not have more than 50 percent involvement with cancer.