Watchful waiting

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Watch & wait is a very reasonable option for some patients. This management is based on a trial by Chodak (et al 1994) who published a phase 2 study of 120 men with stage T1-3 prostate cancer. Although 84% had local progression only 19% required treatment. 11% developed metastatic disease and only 4% died of prostate cancer. Although this trial gives us an idea that many patients could avoid intervention, phase 2 trial are subject to selection bias. Furthermore, there are no randomised trials comparing observation verses early treatment. There are, however, factors which predict which patients with early prostate cancer are likely to progress. The main two are tumour grade and tumour stage (see below) which combined with the patients age gives an idea of which patients should be treatment based on a percentage risk of progression.

 Development of metastases and cancer related deaths from prostate cancer managed by a watch and wait policy (Chodak 1994):- 

 

Metastases %

Deaths %

5 years

10 years

5 years

10 years

T1a G1

6

8

1

4

T1a G2

16

22

6

6

T1b -T2 G1

7

21

2

15

T1b -T2 G2

16

43

3

13

T1 -T2 G3

49

74

33

66

As prostate cancer is so common even if a small percentage of people die of the disease this still represents large numbers per year. As a result it is often a difficult and emotive decision for a patient to defer treatment when he has been labelled with a diagnosis of cancer. Most often patients opt for treatment even though the risks of progression are low and as a result treatment should have as few side effects as possible.


Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.


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