Watchful Waiting
Natural history of untreated prostate cancer
Survival depends on patient age at diagnosis, overall health, and tumor grade and stage at diagnosis. The natural history of prostate cancer is becoming increasingly better understood as long-term data become available.
Among untreated patients with clinically localized prostate cancer, those with a low Gleason score (5 or less) have a very small risk of dying of their cancer within 15 years (4%-7%), if their cancer is never treated. Men with gleason score 6 cancers have a 15-30% risk of cancer death if untreated for 15 years. Those with gleason score 7 cancers have a 50% risk of cancer death if untreated for 15 years. Those with poorly differentiated tumors (Gleason scores 8-10) have an 87% risk of succumbing to the disease within 15 years if untreated.
Watchful waiting can be appropriate for patients whose cancer has been detected at a very early stage in whom the amount of cancer is very small (as measured by PSA test and amount of cancer on biopsy) and when the cancer is not highly aggressive (gleason score 6 or less, and occasionally gleason 7).
The main advantage of watchful waiting is that side effects of surgery, radiation, or hormonal treatment, such as impotence, are avoided. To determine whether or not a cancer is showing signs of having the potential to grow or spread, patients undergo rectal exam, PSA test, and biopsy at regular intervals if they are undergoing watchful waiting. If the cancer shows aggression during follow-up, such as by substantial rise in PSA or increase in amount of cancer on biopsy, then more aggressive treatment (surgery, radiation; or hormonal) can be undertaken.
To learn more about the doctors that comprise the Prostate Care Center team,click here.
Portions of these web pages are based in part on content originally developed by Drs. M. Sanda, N. Shah, K. Pienta and others for the website of the University of Michigan Comprehensive Cancer Center. They are based in part on Cancer Management: A Multidisciplinary Approach: Medical, Surgical and Radiation Oncology, chapter 17, "Prostate Cancer," by K. Pienta, MD, H. Sandler, MD, N. Shah, DO, and M. Sanda, MD. Published by PRR: Melville, NY, 2002.
