The benefits of watchful waiting aren’t that clear for younger men with localized disease—men who probably could be cured if they act in time. The biggest disadvantage here is that what one doctor calls the «window of curability» may silently close forever while the patient is being watched.

If you have curable disease and opt for watchful waiting, you will have to live with uncertainty about the future. At present, there is no reliable way to tell when the disease is just beginning to progress, even if it hasn’t yet escaped the prostate. In about 25 percent of men with growing prostate cancer, there is never a significant, telltale rise in PSA.

So if you’re a man under age 70 with localized, curable prostate cancer who decides to watch and wait, think hard about this risk. You should return to your doctor at regular intervals—every six or twelve months at least—for repeat digital rectal examinations, PSA tests and, probably, yearly prostate biopsies to help doctors find out if the cancer that’s in your prostate is staying put or if it’s on the move. You also need to understand the risks you could be facing down the road if cancer spreads—the long-term symptoms, and the side effects and costs of treatment for advanced disease.

When Watchful Waiting May Be a Safe Gamble

You’re young and healthy enough to have surgery, and your disease is certainly considered curable—in fact, it’s microscopic, probably incidental prostate cancer. Why seek treatment now?

There used to be two polarized schools of thought about this: One was that all of these men needed treatment as soon as possible. «We can definitely cure it now. Time’s wasting—let’s get going!» some doctors said. They urged patients to have their cancer «nipped in the bud,» treated when the chances of curing it were at their peak. The other group was not nearly so optimistic; these doctors believed that treatment didn’t really prolong life by that many years anyway, so what was the point?

*87\201\8*

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