“Men below the age of 65 should usually pursue treatment,” says Michael Kelber, MD, a family medicine physician at Willamette Health Partners.
But for older men, especially those in their 70s and 80s, the slow-growing nature of prostate cancer means the cancer may not become a major problem and they might not need treatment. Most prostate cancers are found in men 65 and older.
“It’s important that doctors give patients the information about their cancer in as open a way as possible and then the patient makes the decision on how to proceed,” Dr. Kelber says.
If you’re 65 or over, or medically too fragile for treatment, your health care provider will likely recommend either active surveillance or watchful waiting. “Those terms are often used interchangeably,” says Nancy Boutin, MD, medical director at Salem Cancer Institute. “But they are different, and it’s important you and your provider have the same understanding.”
With active surveillance, you’ll see your provider regularly, probably every six months, have a regular PSA (prostate specific antigen) blood test, digital rectal exam and repeat biopsies based on your urologist’s assessment. This helps you have a current understanding of the cancer and identify if it’s changing rapidly.
Dr. Boutin says active surveillance is used if you have a potentially curable prostate cancer, you could tolerate treatment in the future, you want to identify the optimum time for treatment, and you’re committed to keeping up with the necessary appointments and tests.
Watchful waiting is useful when you don’t have a curable cancer, or you’re too old or your health is too poor for aggressive cancer treatment. With watchful waiting, you will have fewer tests. “If your goal is to treat the symptoms when they get to be bothersome then your approach can be casual,” Dr. Boutin says.
“The problem seen across the country, and reported in literature, is men who have a curable disease, and have long life expectancy, who go on watchful waiting when they really should have active surveillance,” Dr. Boutin says.
You can use any term, but make sure you and your doctor understand your goals, and your plan is based on your underlying health and those goals.
Prostate cancer is one of the few cancers where you have the option to make choices on how to respond. “Your health care provider can partner with you to make a decision together,” says Dr. Kelber, “and I think that’s the right thing to do.”
Looking for support?
Check out our Prostate Cancer Support Group. It meets monthly and is run by a prostate cancer survivor and his wife and other volunteers.