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Expectant management for men with early stage prostate cancer

hopeful and opt...
Posts: 2218
Joined: Apr 2009

http://onlinelibrary.wiley.com/doi/10.3322/caac.21278/full

This is the most inclusive article that I have come across to date about expectant management for early stage prostate cancer.

H

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Interesting article but I don't think it really adds much to the discussion; just puts the info in one place which is nonetheless useful.

My main quibble about the article is that the authors have created a seemingly meaningless new phrase "expectant managemnt" which they define as:

"Expectant management is a term that encompasses all approaches that defer or avoid treatment via surveillance after a diagnosis of prostate cancer. Expectant management is separated into watchful waiting and active surveillance."

However, when you read through the article, rather than using "expectant management" as a term to encompass both watchful waiting and active surveillance, they use as delineator by describing Watchful Waiting as Expectant Management with Palliative Intent and Active Surveillance as Expectant Management with Curative Intent.

I think that these are distinctions without any differences whatsoever and I would have prefered that they did not use the term "expectant management" at all, since I think there is actually very little difference between the two concepts.

FWIW, I do not recall anyone who used the term Watchful Waiting w/me suggesting that they would restrict treatment to palliative efforts and NOT make a curative effort once more serious PCa was discovered.  To me, the key differences between Watchful Waiting and Active Surveillance is the the implied passive nature of Watchful Waiting vs. the more systematic assessment approach of Active Surveillance.  Other than that, I do not think there really much (if any difference) between the two.

So, creating the term "expectant management" as a further descriptor is IMO wholly unncessary.  It just confuses the discussion and add an additional level of complexity that is not useful.

 

hopeful and opt...
Posts: 2218
Joined: Apr 2009

Agree that there really isn't something new, but the article is very inclusive.

Many times "Active Surveillance" and "Watchful waiting" are incorrectly used interchangeably, but this is not correct.

As I understand, there is a difference between "Active Surveillance with Delayed Treatment, if necessary" which I am doing, and "watchful waiting". Activel Surveillance is actively monitoring low and very low risk patients to include biopseis, etc, and performing curative treatment if necessary. 

 

As sad as it is , here is the definition of watchful waiting from the American Urological Society.

 

"Watchful waiting, as studied in randomized controlled trials (RCTs),101950 is based on the premise that some patients will not benefit from definitive treatment of the primary prostate cancer. The decision is made at the outset to forgo definitive treatment and to instead provide palliative treatment for local or metastatic progression if and when it occurs. Options for local palliation could include transurethral resection of the prostate or other procedures for the management of urinary tract obstruction, and hormonal therapy or radiotherapy for palliation of metastatic lesions.

In contrast to watchful waiting, a program of active surveillance is based on the premise that some, but not all, patients may benefit from treatment of their primary prostate cancer. A program of active surveillance has two goals: (1) to provide definitive treatment for men with localized cancers that are likely to progress and (2) to reduce the risk of treatment-related complications for men with cancers that are not likely to progress."

The above quote comes from..https://www.auanet.org/education/guidelines/prostate-cancer.cfm

 

............I agree with you, using the term expectant management , probably to be inclusive for "AS" and "Watchful waiting" protocols is confusing and unnecessary ...a better choice for description would be more appropriate, say, for example, actually  stating AS and WW protocols.

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