Watchful Waiting

This content has been reviewed and approved by

Daniel P. Petrylak, MD
Associate Professor of Medicine
Director, Genitourinary Oncology Program
Columbia University Medical Center

Can some people with prostate cancer just be watched?

Question: I am a 70 year old just diagnosed with a Gleason 3 + 3 = 6 prostate cancer in 1 of 12 biopsies. My DRE (digital rectal exam) was normal and my PSA was 5.6. Would I be a good candidate for surveillance or watchful waiting?

Answer: This is a question for which the answer is still evolving. Certainly, patients who have serious illnesses other than prostate cancer may be considered for this option.

Generally, patients who are considered to be in a low-risk group (PSA less than 10, Gleason score equal to or less than 6, stage T1c or T2a, and with less than three cores involved and less than 50 percent of any one core involved), who have a PSA doubling time of equal to or greater than 3 years, and are psychologically comfortable with the idea of being watched carefully, are candidates for watchful waiting.

What is surveillance?

Question: I am a 70 year old just diagnosed with a Gleason 3 + 3 = 6 prostate cancer in 1 of 12 biopsies. My DRE (digital rectal exam) was normal and my PSA was 5.6. My doctor said that I might be a good candidate for surveillance or watchful waiting. What is the usual procedure for surveillance?

Answer: This varies amongst physicians. Generally, a digital rectal exam and PSA levels should be taken every 3 to 4 months for 2 years, then every 6 months if the PSA is stable.

Ten to 12 core biopsies should be done yearly for a few years, then every 3 years if there is no change in the Gleason score, number of positive biopsies, or percentage of biopsies involved.

Intervention would be recommended if: PSA doubling time decreased to less than 3 years based on several PSAs. There is a grade progression to Gleason equal to or greater than 7, or an increase in the percentage of cores (greater than 50 percent of any one core), or more than three cores involved.

Is there a group of patients that physicians feel comfortable recommending watchful observation for?

Question: I am 75 years old, have had two heart attacks and was just diagnosed with a Gleason 3 + 3 = 6 prostate cancer. Am I a candidate for watchful waiting?

Answer: This is a difficult question because there does not appear to be a total consensus. However, if a patient understands that there is a risk to both observation and treatment, the group who may be safest to watch are those with small volume disease. One set of criteria to define this group is stage T1c, PSA density equal to 0.15 ng per ml/cm3 or less (this is a number based on your PSA and the size of your prostate), two cores or less with invasive cancer, less than 50 percent cancer invasion in any core, and no Gleason pattern greater than 3.