Watchful Waiting in the Treatment of Advanced Disease
Last Revised November 26, 1995
[developments since 1995 may change the information on this page]
Just as watchful waiting can be applied in the treatment of earlier
stages of prostate cancer, it can also be applied in the later stages.
Again, we would emphasize the fact that watchful waiting is not just a
matter of "doing nothing." Watchful waiting is an active method of
monitoring the patient in order to continually assess the patient's
health status with the intention of offering appropriate treatment as
and when the physician and patient believe such treatment is
necessary.
Advocates of this treatment strategy make the following points in
justifying the correctness of this approach in the management of
advanced prostate cancer:
- Many patients with stage M+ prostate cancer die of other causes
without ever suffering any symptoms of prostate cancer because of the
slow rate of progression of this disease.
- There is no definitive evidence that early hormonal treatment of
stage M+ prostate cancer is associated with a survival benefit.
- There is certainly evidence that medical castration using
pharmaceuticals is associated with a range of adverse effects which can
impact a patient's quality of life.
- There is certainly evidence
that surgical castration (orchiectomy) is associated with physical
adverse reactions and unacceptable psychological effects for many
men.
- Watchful waiting allows a patient to continue his normal
lifestyle without any of the possible adverse effects of treatment.
We would emphasize the accuracy of these statements. However, in the
case of younger patients whose major concern may be their long-term
survival, it may be difficult to accept the concept of non-treatment of
a form of cancer which clearly causes death in approximately 3% of
patients.
One other factor should also be carefully considered in favor of
watchful waiting. It has never been determined whether the institution
of hormonal therapy may actually accelerate the growth of
hormone-resistant prostate cancer cells. In other words, it is possible
that although initiation of hormonal therapy slows the growth of
prostate cancer over all, it may speed up the growth of
hormone-resistant prostate cancer cells. If that were ever found to be
the case, it would probably favor arguments for either delaying hormone
therapy or at least maximizing the use of intermittent hormone therapy,
which are discussed in more detail elsewhere.
|
|
