This can lead to a better quality-of-life, and for some, may never result in prostate cancer treatment. 2017 Dec 15. pii: S0022-5347(17)78003-2 . For older men who have a limited life expectancy, watchful waiting may be more appropriate. RR relative risk, RP radical prostatectomy, AS active surveillance, WW watchful waiting RR_lowrisk_WW: relative risk of cancer progression for low risk patients compared to localised prostate cancer patients in the watchful waiting arm Lao et al. Loeb S(1), Zhou Q(2), Siebert U(3), Rochau U(4), Jahn B(4), Mühlberger N(4), Carter HB(5), Lepor H(6), Braithwaite RS(2). 05 October 2017 . in the USA only ≈5% of the patients in the CaPSURE database were managed by watchful waiting in 2002 , while in Sweden watchful waiting or active surveillance was used in ≈20% of all new cases in 2005 . Pick whichever option … Urol Nephrol Open Access J, 6(6), 173-176. Results: Overall 13,272 (46%) men with low risk and 8,695 (30%) with intermediate risk prostate cancer chose deferred treatment. Watchful waiting and active surveillance. These men may be older adults without significant or chronic health issues. Only 3% received hormonal therapy. For men with low-risk prostate cancer, this is a safe option that can preserve the quality of life. Watchful waiting, which is different from active surveillance, is an option for certain high risk men or older men with multiple co-morbidities. Data have been added supporting that comorbidity status is the leading cause of death at ten years, especially for Charlson score = 2, irrespective of age, even for those with an aggressive tumour. Active surveillance was introduced to prevent overtreatment and reduce costs while preserving the option of radical prostatectomy. Active surveillance means that instead of getting immediate treatment, a patient regularly visits his doctor for exams, prostate-specific antigen (PSA) tests, and periodic prostate biopsies. CONTRASTING AA vs WW AS WW Treatment intent … Watchful waiting vs. active surveillance: Which treatment option is right for patients with localized prostate cancer. Both options are generally offered to men with low-risk, low-grade prostate cancer (Gleason score ≤6 and low PSA ≤10).2 However, the two management options for prostate cancer are separate strategies with different enrollment criteria and separate purposes. Active Surveillance is only a good choice for men whose lives are expected to be long enough to benefit from curative therapy should the cancer become more aggressive over time. Some doctors say “active surveillance” or “watchful waiting” to mean the same thing: tracking the cancer and how it may or may not grow. And some healthcare providers see these as 2 different things. These can mean different things to different people, so ask your doctor or nurse to explain exactly what they mean. Urol Nephrol Open Access J, 6(6), 173-176. This study aims to evaluate the cost-effectiveness of active surveillance compared to watchful waiting and radical prostatectomy. The two are very different and should not be confused with one another. Active Surveillance vs. Watchful Waiting . Active Surveillance is delayed treatment, which may result in having treatment if the man’s situation worsens. Active surveillance is a management option for localized prostate cancer that can be offered to appropriate patients who would also be candidates for aggressive local therapies (surgery and radiotherapy), with the intent to intervene if the disease progresses. Active surveillance (Hopkins) is preferred with a shorter duration and less utility decrement from treatment complications, and with an increasing probability of metastasis for untreated grade reclassification, whereas watchful waiting has more QALYs with a large decrement in utility and long duration of treatment-related complications, and with a higher discount rate. Watchful waiting; Discussion 6 Sociocultural aspects of PSA Testing in Australia; Appendices. Others think these terms are slightly different. Sanda MG, et al. Active Surveillance Versus Watchful Waiting for Localized Prostate Cancer: A Model to Inform Decisions. Other reasons for discontinuations included anxiety, switch to watchful waiting, death, and loss to follow-up. Unlike active surveillance, watchful waiting carries a palliative, non-aggressive intent, and does not involve routine cancer monitoring including biopsies. Active surveillance or watchful waiting for low-risk prostate cancer is on the rise in the United States, but their use varies geographically, a study found. Therefore, delaying therapy in favor of careful surveillance, with the expectation of delivering curative treatment upon evidence of progression, is an attractive concept. ACTIVE SURVEILLANCE WATCHFUL WAITING (observation) Decision is made at the outset to forego definitive treatment (comorbidities & life expectancy) and to provide systemic or local treatment to palliate symptoms if disease progresses locally or at distant metastatic sites. Dr Chris Parker, Consultant Clinical Oncologist, with a patient. Watchful waiting is never being treated, regardless of the man’s situation. At the time of my C&P in 2012, My PSA readings had been ranging from .1-.5 for several years and my oncologist was seeing me every 3-4 months. Ron91: "Watchful waiting/active surveillance" can be very subjective. During active surveillance for prostate cancer, your doctor closely monitors your prostate cancer for any changes. They are specifically studying a recent trend of what is known as “active surveillance” or “watchful waiting,” that reduces the rush to treatment and opts out of immediate surgery or radiation. Limitations of this study include possible nondetection and misclassification of treatment outside the VA that was not captured, difficulty distinguishing active surveillance vs watchful waiting using administrative codes, and inability to determine participation in shared decision making. Currently, active surveillance is an acceptable option for the management of low risk prostate cancer. J Urol. They will be asked to repeat their PSA labs every six months, undergo a digital rectal exam every six to 12 months, and a prostate biopsy annually. Overall, 1,768 men discontinued active surveillance during follow-up, 1,102 due to protocol-based reclassification. Original Article from The New England Journal of Medicine — Radical Prostatectomy or Watchful Waiting in Prostate Cancer — 29-Year Follow-up In this review, we discuss active surveillance, contrast it to watchful waiting, and define common inclusion criteria. Active surveillance is often confused with watchful waiting, which is another way of monitoring prostate cancer. The only time a man may do this is if he is very old or has other serious co-morbidities. There has been a long debate in the medical community about the value of treatment to destroy cancer cells vs. watchful waiting, also known as active surveillance… Watchful waiting vs. active surveillance Watchful waiting and active surveillance are often mistakenly interchanged. Subclassification of very low risk disease, and active surveillance vs watchful waiting was possible beginning in 2007. Active Surveillance . Active surveillance is sometimes also called watchful waiting. The current use of watchful waiting varies worldwide and, e.g. My C&P nurse practitioner reported my cancer as in remission and I was awarded residuals. Both watchful waiting and active surveillance are perfectly fine options, but you can only choose one at a time. The concept of watchful waiting (synonymous, for some doctors at least, with 'active surveillance') is nothing new. Two-thirds (67%) of the men were treated with either radical prostatectomy or radiation therapy after discontinuation. ACTIVE SURVEILLANCE WATCHFUL WAITING (observation) Decision is made at the outset to forego definitive treatment (comorbidities & life expectancy) and to provide systemic or local treatment to palliate symptoms if disease progresses locally or at distant metastatic sites. You may have more exams and tests over time with active surveillance, and fewer with watchful waiting. Active surveillance for prostate cancer is sometimes called expectant management or watchful waiting. Active surveillance (Hopkins) is preferred with a shorter duration and less utility decrement from treatment complications, and with an increasing probability of metastasis for untreated grade reclassification, whereas watchful waiting has more QALYs with a large decrement in utility and long duration of treatment-related complications, and with a higher discount rate. Sanda MG, et al. With watchful waiting, patients who develop symptomatic progression from prostate cancer are offered treatments to palliate these symptoms. When searching for information about active surveillance, you may have come across the term watchful waiting. Similar to watchful waiting, men under active surveillance have low grade (Grade 1 / Gleason 6), low volume cancer. Watchful waiting/active surveillance: Additional data on the impact of radical prostatectomy compared to watchful waiting (WW) has been added. Active surveillance ; Discussion 5 Watchful waiting. Your healthcare provider will tell you which term he or she uses, and what it … Author information: (1)Department of Urology, New York University, New York, NY, USA; Department of Population Health, New York University, New York, NY, USA. Also, digital rectal exams and prostate biopsies are done once every 12 months. J Urol. Some people use names such as ‘active monitoring’ and ‘wait and see’ to describe both active surveillance and watchful waiting. It’s important to understand the difference between watchful waiting and active surveillance in order to make an informed decision about a patient’s prostate cancer treatment plan . My present "appeal" is based on this very issue. Generally, the doctor repeats PSA blood tests about every 6 months. No cancer treatment is provided during active surveillance for prostate cancer. Active surveillance and watchful waiting are emerging as important management options for men diagnosed with early-stage prostate cancer. Watchful waiting and active surveillance are not generally recommended for such patients today (but there are certainly some younger patients who will go on active surveillance for significant periods of time before electing to have treatment). This segment of this website is devoted to Watchful Waiting, and Active Surveillance.. This cancer epidemiology study uses SEER data to examine US trends in use of active surveillance, watchful waiting, radiotherapy, and surgical management of localized prostate cancer among men with low-, intermediate-, and high-risk disease treated between 2010 and 2015. The decision is up to you and your doctor. We examined primary treatment selection by risk group and used logistic regression to evaluate factors associated with deferred treatment. Although both are used as a way to avoid unnecessary treatment, they have their differences.
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