Advice for Men with Prostate Cancer: Q&A with Dr. Warlick

Q. When are "watchful waiting" and "active surveillance" good options for men with prostate cancer?

A. Treatment options for prostate cancer that is confined to the prostate gland include surgery, radiation, and observation. Physicians at the Institute for Prostate and Urologic Cancers work with men and their families to determine the best option for each individual. Factors in the decision-making process include the apparent aggressiveness of the disease, other health concerns, and life expectancy, as well as the patient’s personal views on illness, experiences with cancer, and priorities in what they consider to be an acceptable quality of life.

Studies have estimated that 200 to 300 men over age 65 are treated to prevent one man from dying from prostate cancer. This suggests that prostate cancer may be over treated, as many men may ultimately die of an unrelated cause, and that observation as a management strategy for localized prostate cancer may be underutilized.

Observation for prostate cancer can be conducted in two ways: “watchful waiting” or “active surveillance,” also known as “expectant management.”

“Watchful waiting” is observing the progression of prostate cancer in men who are too old or too ill from other diseases for curative therapy for their cancer. If their prostate cancer progresses, these men are treated with hormonal therapy, which controls the prostate cancer but doesn’t cure it.

“Active surveillance” is a form of observation for healthy, older men with low-grade, low-stage prostate cancer whose disease may not require treatment immediately, or at all. If their prostate cancer progresses, physicians normally recommend curative therapy in the form of either surgery or radiation therapy.

The rationale for observing some prostate cancers is to postpone or avoid the side effects associated with surgery or radiation therapy, which can include incontinence and erectile dysfunction.

However, observation is not for everyone. There are strict clinical criteria required for men who want to pursue active surveillance.

Furthermore, despite encouraging studies examining the safety of active surveillance, there still remains a risk that the disease will progress to an incurable state during the observation period. Current research is focusing on how to identify the best candidates for active surveillance, identify the optimal surveillance strategy, and identify the appropriate triggers for intervention while the cancer is still curable.

Christopher Warlick, M.D., Ph.D., is a urologic surgeon at the Institute for Prostate and Urologic Cancers. An assistant professor in the Department of Urology., Warlick has a doctorate in pathobiology and specializes in treating prostate, kidney, and bladder cancer.

- Story courtesy University of Minnesota Foundation

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