Prostate cancer

Watchful waiting (also known as expectant management) is a management option available to men with early-stage prostate cancer.

It’s defined as initial surveillance followed by active treatment if and when the tumour progresses to cause bothersome symptoms. The NHMRC guidelines recommend this option for patients with well-to-moderately
differentiated tumours, low volume disease, low PSA and a life expectancy of less than ten years. The goal of watchful waiting is to spare early-stage prostate cancer patients unnecessary treatment-related toxicity and to maintain reasonable quality of life (QOL) without compromising survival.

However, while watchful waiting avoids the complications of surgery and radiotherapy, many patients and their partners report distress from living with continual uncertainty. In fact, research has found that the majority of men are willing to be impotent or incontinent to have their cancer cured.1

Some patients consider that watchful waiting amounts to ‘doing nothing’, perhaps because they are not fully aware of the ongoing need for vigilant follow-up and regular monitoring. As the NHMRC guidelines suggest, a watch and wait approach is an appropriate choice only when a fully-informed patient has a preference for no treatment.