10: Watchful Waiting

WATCHFUL WAITING 10

What is watchful waiting?

Watchful waiting is a form of monitoring prostate cancer without treating it. It is often used for men who are older and who have cancer that is slow growing and unlikely to alter their natural survival. It can also be used for men who are too sick with other life-threatening illnesses to benefit from treatment. The monitoring is less aggressive and less intense than with active surveillance protocols. The aims are to maintain quality of life and to watch the cancer until it spreads to other places or if it starts to cause symptoms. At that point, patients may opt to start treatment to slow the growth of the cancer.

Why is watchful waiting used?

• To avoid risks of treatments and any side effects • Avoid repeated tests and biopsies • To control the cancer but not necessarily cure it

Who can be on watchful waiting?

• Men who do not want treatment or have no symptoms from their cancer • Men who cannot have treatment • Men with other life-threatening medical illnesses • Cancer that is localised • Men with slow-growing cancers • In men with cancer that has spread after discussion – usually to avoid further detrimental side effects of treatments

What does watchful waiting involve?

• Regular monitoring, either with a urologist or your GP, usually of your PSA blood test and your symptoms – this may be every 6 -12 months • Fewer tests than active surveillance • You may need scans to assess if the cancer has spread but most men do not require invasive biopsies

What symptoms should I look out for?

• Bone Pain • Difficulty passing urine • Deteriorating kidney function • Blood in your urine • New back pain – either central or located to one side • New swelling in your legs, especially if only one leg is involved If you develop any of the above, your doctor may start you on hormone therapy to help control the cancer. Without any signs that the cancer is getting worse, you can stay on monitoring.

My urologist told me that I was more likely to die with the cancer than of it. That was enough to get on with life rather than suffer with side effects of unnecessary treatment.