If you or a loved one is facing prostate cancer, you may have become interested in (or confused by) the recent debate over whether early treatment or watchful waiting is the best course of action. I believe that no physician or government agency should make the decision on which path one should take. However, helping your man understand the pros and cons of his options can go a long way toward a decision in which you both can be comfortable and confident. Here are some key considerations when you're weighing the options.
Pro – Many types, but not all, prostate cancers grow slowly. As the media has given much attention to this point, it is true that prostate cancer will not necessarily cause death in every man who gets it. With this in mind, certain men who have slow growing and small amounts of cancer in their prostate are candidates to wait it out. If he's comfortable that he is watching the cancer carefully and his physician is not finding any progression of the cancer, then this option can be fine for some men.
Con – In order to be effective, watchful waiting must be just that – Watchful. This doesn't mean the prostate cancer should be ignored. If this is the option selected, careful and frequent-enough-to-be-useful consultation must be made with a prostate cancer specialist throughout the remainder of a man's life. Even then, there is no guarantee that in between appointments the cancer won't take a particularly accelerated or aggressive turn for the worse, leaving a man without the treatment options he may have had when the prostate cancer was in its earlier stages.
Pro – When it comes to a cancer diagnosis of any kind, prostate included, most people are braver than they give themselves credit for being. They want to handle it. In many cases, the sooner a man proceeds with treatment, the better. For many men, undergoing treatment early has a number of benefits.
Cancer, no matter the type, doesn't always take the same course, with the same speed, in every individual. The time it takes for one man to progress from early stage prostate cancer to terminal prostate cancer may be shorter or longer than the next man. With this understanding, many men make the proactive decision to remove the cancer before it has the opportunity to become a bigger problem. Does this mean it will absolutely become a bigger problem? No. The bottom line is that we can't predict the exact course that prostate cancer will take in every man. What we do know to be true is that treatment in prostate cancer's early stages is typically more successful, curative and less complicated than attempted treatment in later stages.
Con – Like any cancer treatment, prostate cancer treatment involves risks. Whether it's radiation therapy, surgery, or something else entirely, these choices are never without risk. Men need to be informed of their treatment options, then carefully and thoughtfully weigh those options and their risks against the option to "watchfully wait."
What I don't want to see in this "Watchful Waiting" vs. "Early Treatment" debate is for men and their loved ones to become so confused that they do nothing at all. The decision on the course of treatment is as unique to the individual as the path his cancer might take. Age, overall health, heredity and other factors play a significant part in this decision for many men. Choosing and speaking candidly with a urologist who specializes in prostate health is key to helping your man make the best and most informed decision possible.