Update on watchful waiting for prostate cancer

With the advent of widespread prostate-specific antigen screening, smaller volume prostate cancers are detected earlier. Given the long natural history of such tumors, watchful waiting may represent an effective management strategy for some men. Recent evidence regarding this strategy and our experience is highlighted.

Watchful waiting as traditionally practiced involves the institution of palliative therapy as the disease progresses at a time when cure is no longer possible. Recent research and some key discoveries related to preoperative parameters predicting disease significance have resulted in a new form of watchful waiting. Expectant management with curative intent aims to follow patients with early diagnosed, small volume low grade disease without immediate therapy. Curative treatment is then initiated at the first sign of progression at a time when cure is still possible. Studies regarding patients managed expectantly and retrospective reviews of treatment trends along with new predictive nomograms continue to shed light on expectant management as an option for men with clinically localized prostate cancer.

Expectant management has evolved to include cure as its ultimate goal. Early data regarding such a strategy indicate that it may be a reasonable alternative for a select group of older men. For men with a long life expectancy, disease is likely to progress and such a strategy is not currently recommended. The long-term efficacy of this approach will be determined with further follow-up.