The authors found that for patients with Gleason 3+4 PCa, a 90 day delay from biopsy to prostatectomy significantly increased their risk of biochemical recurrence (meaning a detectable or rising PSA after surgery, when PSA should drop to zero) vs. those who had surgery sooner.
Full Answer
What is watchful waiting for prostate cancer?
Instead of using active surveillance to track routine test results, patients simply observe their own symptoms and inform their doctor if changes occur. The goal of watchful waiting is to observe the prostate cancer until it has metastasized (spread to distant sites) or started to cause symptoms such as pain or blockage of the urinary tract.
Are patients with newly diagnosed cancer waiting longer to begin treatment?
These findings reveal that patients with newly diagnosed cancer are having to wait longer to begin treatment, a delay that is associated with a substantially increased risk of death.
Should you delay prostate cancer treatment?
And, if the informed decision is to delay treatment, do it with responsible, well-monitored active surveillance. You’ve just had a prostate biopsy, and you’re waiting for the results. You figure you’ll get a head start on researching your options.
How often should a prostate exam be done?
Usually this approach includes a doctor visit with a prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) about every 6 months. Prostate biopsies may be done every year as well.
Why is early screening so important for prostate cancer?
Screening is testing to find cancer in people before they have symptoms. For some types of cancer, screening can help find cancers at an early stage, when they are likely to be easier to treat. Prostate cancer can often be found early by testing for prostate-specific antigen (PSA) levels in a man's blood.
Why is watchful waiting for prostate cancer?
Watchful waiting is a way of monitoring prostate cancer that isn't causing any symptoms or problems. The aim is to keep an eye on the cancer over the long term, and avoid treatment unless you get symptoms. Prostate cancer is often slow growing and may never cause any problems or symptoms.
Does time from diagnosis to treatment of high or very high risk prostate cancer affect outcome?
Conclusion. In this pooled meta‐dataset of patients with high‐risk or VHR prostate cancer, time from diagnosis to RP did not appear to significantly contribute to differences in clinical outcomes.
Can you wait to treat prostate cancer?
Because prostate cancer often grows very slowly, some men (especially those who are older or have other serious health problems) who have it might never need treatment. Instead, their doctors may recommend observation (sometimes called watchful waiting) or active surveillance.
When should you watch and wait for prostate cancer?
The goal of watchful waiting is to observe the prostate cancer until it has metastasized (spread to distant sites) or started to cause symptoms such as pain or blockage of the urinary tract. At that point, patients may choose treatment.
What is the benefit of watchful waiting?
The main benefit of watchful waiting is that it avoids many treatment and surveillance-related risks, problems and side effects. However, with this approach the cancer could grow and spread between follow-up visits and ultimately make it harder to treat.
At what PSA level should a biopsy be done?
A lower percent-free PSA means that your chance of having prostate cancer is higher and you should probably have a biopsy. Many doctors recommend a prostate biopsy for men whose percent-free PSA is 10% or less, and advise that men consider a biopsy if it is between 10% and 25%.
How long should you wait between prostate biopsies?
Indeed, a recent review shows that a third or more of patients with very low or low risk prostate cancer at diagnosis have disease upgraded upon resam- pling within 6 months. 2 For men who opt for active surveillance, most protocols recommend repeat biopsy within the first year and then every 1 to 5 years thereafter.
How soon after prostate biopsy can I have surgery?
Traditionally, surgery is performed 6 to 8 weeks following a needle biopsy of the prostate and a minimum of 12 weeks following a transurethral resection of the prostate (4).
How long can you delay prostate cancer treatment?
Meaning These findings suggest that prostate cancer surgery can be safely delayed up to 6 months and should be considered as low priority compared with other emergent and cancer surgeries when health care resources need to be prioritized during special times, such as the coronavirus disease 2019 pandemic.
Can prostate biopsy be delayed?
The median delay between mpMRI and transperineal biopsy was 5 months, and 90% of patients had a delay of 8 months or less. Biopsy delay time was 3 months or less for 59 patients (early biopsy group) and more than 3 months for 136 patients (late biopsy group).
Can you delay prostate surgery?
Prostate cancer surgery in high-risk patients can safely be delayed for as long as 6 months and should therefore be considered a low priority compared with other cancer and emergent surgeries when healthcare resources must be prioritized, a large U.S. database study found.
What is the Gleason score for prostate cancer?
Is only in your prostate. Has a prostate-specific antigen ( PSA) level less than 10 ng/mL. Has a Gleason score of 7 or less, which means your cancer is slow-growing.
Why do doctors want to keep an eye on cancer?
But doctors still want to keep an eye on the cancer so they can take action if it gets worse. This approach is known as active surveillance or watchful waiting. Your doctor may have suggested these options instead of other treatment for a few reasons: Your age. Other health conditions you have, such as heart disease, diabetes, stroke, ...
What is the risk of active surveillance?
A risk of active surveillance is that it can give the cancer a chance to grow or spread. That can limit your options for treatment later. But if the cancer is growing, it will probably be caught and treated. For many men, this never happens, so they don't have any potential consequences of unnecessary treatment.
What does "watchful waiting" mean?
Some doctors say “active surveillance” or “watchful waiting” to mean the same thing: tracking the cancer and how it may or may not grow. Others think these terms are slightly different. If your doctor mentions either term, ask them exactly what they mean by it.
Can prostate cancer patients live after radiation?
They have found that men with slow-growing tumors who choose active surveillance are likely to live as long after their prostate cancer diagnosis as men with slow-growing tumors who have surgery or radiation right away.
Can you watch for prostate cancer?
With watchful waiting, there are fewer tests . Instead, your doctor will watch to see if you get any prostate cancer symptoms. If you do, you and your doctor will talk about next steps. This could be treatments for the cancer. Or it could be treatments that will control the symptoms.
Can you wait to see if you have cancer?
Not have any symptoms. Feel OK about waiting to see if your cancer grows. (You’re in charge of all your treatment decisions.) Be able to go about your day-to-day life and not worry that your cancer will spread. Understand the benefits and risks of your decision to follow active surveillance.
Is prostate cancer the second leading cause of cancer deaths?
Even so, prostate cancer remains the second leading cause of cancer deaths (after lung cancer) in men, according to the American Cancer Society. To continue reading this article, you must log in.
Is prostate cancer better than heart disease?
Over the years, the outcome for prostate cancer has turned out to be better than expected for many men. While prostate cancer is quite common, the risk of dying from the disease is low, even without treatment. In fact, most diagnosed men will die from something else, like heart disease. Even so, prostate cancer remains the second leading cause ...
What does it mean to watchful wait for a cancer test?
Observation (watchful waiting) is sometimes used to describe a less intensive type of follow-up that may mean fewer tests and relying more on changes in a man’s symptoms to decide if treatment is needed.
Why are men not comfortable with observation?
Other men are not comfortable with observation or active surveillance because the cancer might grow and spread, limiting treatment options and the possibility of treating the cancer successfully. Some men accept the possible side effects of treatments to try to remove or destroy the cancer.
Can prostate cancer be monitored?
Instead, their doctors may recommend observation (sometimes called watchful waiting) or active surveillance.
Is a low PSA level good?
Is associated with low PSA level (<10ng/ml) They are not likely to be good options if you have a fast-growing cancer (for example, a high Gleason score) or if the cancer is likely to have spread outside the prostate (based on PSA levels).
Can you treat slow growing cancer with radiation?
Observation and active surveillance are reasonable options for some men with slow-growing cancers because it is not known if treating the cancer with surgery or radiation will actually help them live longer. In active surveillance, only men whose cancer is growing (and therefore have a more serious form of cancer) are treated.
Can prostate cancer patients live longer after surgery?
Some have found that men who have surgery might live longer, while others have not found a difference in survival.
Is it safe to wait?
A 2015 study published by University of Chicago researchers concluded that men diagnosed with low-risk PCa “… may safely use the time following their initial biopsy to consider management options and obtain a restaging biopsy, if recommended,” for up to a year without raising risk of recurrence.
Not so safe after all
A 2018 paper presented at the 33 rd European Association of Urology Congress (Copenhagen, Denmark) underscores my concern. This was a much smaller study of 513 men at a single French medical center.
A better way
Let me approach this differently. Rather than ask, “Is it safe to delay treatment after prostate cancer diagnosis?” I would pose the question, “How can we make it safer to delay treatment after prostate cancer diagnosis?” The answer is, change the diagnosis and monitoring protocol.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions.
Can cancer patients wait to start treatment?
These findings reveal that patients with newly diagnosed cancer are having to wait longer to begin treatment, a delay that is associated with a substantially increased risk of death. The researchers used prospective data from the National Cancer Database and examined the number of days between diagnosis and the first treatment for persons ...
Do patients with cancer wait longer to get treatment?
Patients with newly diagnosed cancer are having to wait longer to begin treatment, study data indicates. Greater efforts are needed to prevent treatment delays for patients with cancer, according to research presented at the 2017 American Society of Clinical Oncology (ASCO) Annual meeting.
What type of cancer needs to be treated right away?
You have a type of cancer that needs to be treated right away, like some leukemias, lymphomas, and certain other cancers that tend to be aggressive (grow and spread very fast). You have a tumor that's pressing on an organ or other vital part of the body, and treatment is needed to relieve the pressure.
Do you need to make adjustments before starting treatment?
You want more time to get a second opinion. It's important to know each person's case is different.
Can you wait to get lab results back?
You are waiting to get lab results back that will help decide what treatment option is best. You have already had surgery to remove a tumor, and you need time to recover before starting more treatment. You need to make adjustments at home, work, or for child care before starting treatment.
Does cancer need to be started right away?
Does cancer treatment always need to be started right away? Sometimes, it's important to start treatment as quickly as possible, but that's not always the case. Planning cancer treatment can be complex and might take some time, depending on the type and stage of your cancer.