Watchful Waiting

Candidates: Men with early-stage cancer (nonpalpable; PSA and Gleason score 5 or less) who are over age 70 or who expect to live less than ten more years. Some men choose this option if short-term preservation of sexual function is paramount.

Chance of cure: Remote.

Convenience: Excellent; a rectal exam, a PSA test, and possibly a biopsy every few months are usually all that is necessary.

Sexual side effects: None unless the cancer progresses.

Urinary side effects: None unless the cancer progresses.

Bowel side effects: None unless the cancer progresses.

Other side effects: None.

Follow-up treatment if needed: PSA is only moderately useful as a marker, since the cancer can spread even with a low PSA. The PSA velocity may be more useful. All treatment options remain open unless the cancer spreads outside the prostate.

Uncertainties: Many; you know you have an untreated cancer growing inside you.

Unknowns: Rate of growth; whether the cancer has spread; precise Gleason score.

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