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CA Cancer J Clin. 2015 Jul-Aug;65(4):265-82. doi: 10.3322/caac.21278. Epub 2015 May 8.

Expectant management for men with early stage prostate cancer.

Author information

1
Health Services Research Fellow, Department of Urology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA.
2
Professor of Urology, Department of Urology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA.
3
Chair and Professor of Urology, Department of Urology, David Geffen School of Medicine at UCLA; Professor of Health Services, Department of Health Policy and Management, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA.

Abstract

Since the dissemination of prostate-specific antigen screening, most men with prostate cancer are now diagnosed with localized, low-risk prostate cancer that is unlikely to be lethal. Nevertheless, nearly all of these men undergo primary treatment with surgery or radiation, placing them at risk for longstanding side effects, including erectile dysfunction and impaired urinary function. Active surveillance and other observational strategies (ie, expectant management) have produced excellent long-term disease-specific survival and minimal morbidity for men with prostate cancer. Despite this, expectant management remains underused for men with localized prostate cancer. In this review, various approaches to the expectant management of men with prostate cancer are summarized, including watchful waiting and active surveillance strategies. Contemporary cancer-specific and health care quality-of-life outcomes are described for each of these approaches. Finally, contemporary patterns of use, potential disparities in care, and ongoing research and controversies surrounding expectant management of men with localized prostate cancer are discussed.

KEYWORDS:

active surveillance; expectant management; prostate cancer; watchful waiting

PMID:
25958817
DOI:
10.3322/caac.21278
[Indexed for MEDLINE]
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