Therapeutic dilemmas in prostate cancer: justification for watchful waiting

Despite the large numbers of elderly men known to harbour pathological evidence of prostate cancer and evidence from observational studies suggesting the prolonged time course of such disease, conservative management of such patients has not enjoyed the widespread support of urologists, particularly in the USA, where monitoring of patients is often dismissed as 'intentional neglect' rather than 'watchful waiting'. This paper outlines the rationale and principles underlying expectant treatment of patients with prostate cancer.