Now is the time for some plain speaking, so here goes: At the top of this list should be men who are too old or too ill either to undergo the rigors of treatment or to live another ten years—long enough for such treatment to be worthwhile. Also in this group should be men who don’t want to experience the side effects associated with “definitive,” or curative treatment; men who are diagnosed with stage T3, T4 or N+ (C or D) disease who don’t yet have symptoms; men whose prostate cancer is truly incidental and not yet something to worry about (some men with stage Tia or Ai cancer, and men with stage Tic disease who have low Gleason scores and low PSA densities.

The advantages of watchful waiting include its initial freedom from side effects and, at first, the financial break—it’s the cheapest option because there’s no expensive treatment to pay for.

Watchful waiting doesn’t mean “do nothing,” and it doesn’t mean your doctor has written you off—it means you get treatment for specific symptoms when you need it. This can mean hormone treatment or spot radiation to ease bone pain; it can mean a TUR or other procedures to bring relief when the prostate cancer becomes large enough to obstruct the urinary tract; it can mean a host of options aimed at tackling specific problems, prolonging life and easing pain.


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