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Update on watchful waiting for prostate cancer
Mohamad E Allaf1, H Ballentine Carter
1The Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Current Opinion in Urology
|April 8, 2004
Summary
Watchful waiting for early prostate cancer has evolved to expectant management with curative intent. This approach may suit select older men, offering treatment if the disease progresses.
Area of Science:
- Urology
- Oncology
Background:
- Widespread prostate-specific antigen (PSA) screening detects smaller prostate cancers earlier.
- Prostate cancer often has a long natural history, making watchful waiting a potential management strategy.
Purpose of the Study:
- To highlight recent evidence and clinical experience with watchful waiting for prostate cancer.
- To discuss the evolution of watchful waiting into expectant management with curative intent.
Main Methods:
- Review of recent research and key discoveries in preoperative parameters predicting prostate cancer significance.
- Analysis of studies on expectantly managed patients and retrospective reviews of treatment trends.
- Incorporation of new predictive nomograms for prostate cancer management.
Main Results:
- Traditional watchful waiting involved palliative therapy upon disease progression, when cure was no longer possible.
- Expectant management with curative intent involves monitoring low-grade, small-volume prostate cancer without immediate therapy.
- Curative treatment is initiated at the first sign of progression, aiming for a cure.
Conclusions:
- Expectant management has evolved to incorporate cure as its ultimate goal.
- This strategy may be a reasonable alternative for a select group of older men with prostate cancer.
- Long-term efficacy requires further follow-up; not recommended for men with long life expectancy due to likely disease progression.