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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.

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The content in this section of the Phoenix 5 site was originally developed by CoMed Communications (a Vox Medica company) as part of The Prostate Cancer InfoLink. It is reproduced here with the permission of Vox Medica.

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