Prostate watchful waiting

Flanigan RC, Reda DJ, Wasson JHM, et al. 5 year outcome of surgical resection and watchful waiting for men with moderately symptomatic benign prostatic hyperplasia a Department of Veterans Affairs cooperative study. J Urol 1998 160 12-17. 

In the bicalutamide prostate cancer programme, the adjuvant treatment of patients with advanced prostate carcinoma (T1-T4 NO/NX, MO) with bicalutamide (150 mg, once a day) was evaluated. 4052 patients were randomised to bicalutamide with best standard care (either radiation, prostatectomy or watchful waiting ), whereas 4061 patients received a placebo with best standard care. An initial reduction of prostate cancer recurrence, which was observed in an interim analysis, later was not confirmed [219]. As the survival time in the bicalutamide treatment group was decreased, the study was terminated ahead of time. 

The management of lower urinary tract symptoms suggestive of clinical symptomatic BPH remains somewhat controversial. Treatment options range from watchful waiting, for those patients wishing to delay any active therapy, to minimally invasive treatment, such as transurethral needle ablation of the prostate and transurethral microwave therapy, to surgical interventions in the form of transurethral prostatectomy or open enucleation of the prostate. Most patients present with difficulties in urination for which a variety of medical therapies are available, including synthetic 5-a-reductase inhibitors, a-blockers, and plant extracts (Boyle et al., 2000). 

In patients who have complications of BPH, surgery is required. Although it has more adverse complications than does pharmacotherapy or watchful waiting, transurethral resection of the prostate is considered the gold standard. 

Wasson JH, RedaDJ, Bruskewitz RC, etal, fordie Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. N Engl J Med 1995 332 75-79. 

Treatment options for clinically localized prostate cancer include radiation therapy, surgery, or watchful waiting. There is currently no evidence to suggest which therapy is the most cfinicaUy effective, and treatment choice is often made by patient or physician preference. However, there are large economic differences in the therapies, with the cost of a radical prostatectomy 12,000 more expensive than watchful waiting, and radiation therapy 15,000 more expensive than watchful waiting. ... 

Schroder EH, de Vries SH, Bangma CH. Watchful waiting in prostate cancer review and policy proposals. BJU Int 2003 92 851-859. 

Demichelis F, Fall K, Perner S, et al. TMPRSS2 ERG gene fusion associated with lethal prostate cancer in a watchful waiting cohort. Oncogene. 2007 26 4596. 

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