Watchful waiting

Few data are available on the results of watchful waiting for men with prostate cancer. Common sense dictates that this group of men will not suffer the immediate toxicity of treatment, and should maintain quality of life consistent with age-matched men without prostate cancer. However, in a combined series from Massachusetts General Hospital and Eastern Virginia Medical School, men frequently proceeded to definitive treatment within the first decade: 57% at 5 years, and 74% at 7 years.67 The authors noted that slight increases in PSA often triggered treatment, but that physicians often perceived the patients initiated treatment, while patients perceived just the opposite. In addition, Jonler etal.68 studied quality of life in a group of 71 patients from Denmark who elected watchful waiting. During follow-up, 31% had required transurethral resection of the prostate (TURP), 8% underwent XRT and 44% hormonal deprivation. They found high rates of incontinence (21% using pads, 37% leaked daily), and significant reduction in sexual function. Nevertheless, the satisfaction rate was 85%. More data are needed regarding emotional or other effects of watchful waiting. In the meantime, available evidence suggests that watchful waiting often represents delayed therapy, and that QOL benefits may only be temporary.

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