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Both Active Surveillance AS and Watchful Waiting WW are used to describe the choice made by men who elect not to have immediate conventional treatment.
A distinction is often made between the two: Active Surveillance AS involves undertaking a number of measures to track any changes in a diagnosed early stage, low risk or very low risk disease.
In the event that there are significant changes, conventional treatment is undertaken with the intention of effecting a cure. Watchful Waiting WW involves tracking changes and looking to manage any progress of the disease without having initial invasive therapy.
The premise of both WW and AS is that most prostate cancers diagnosed today are slow growing. If the cancer is early stage and low or very low risk there is a good probability that the man in whom it is detected may die of another cause. Undertaking conventional treatment with all the attendant negative consequences may be unnecessary in such cases.
For men with low-risk, early stage, localized prostate cancer who are older than 65 years of age and have a life expectancy of not more than 15 years, observation i. For men with low-risk, early stage, localized prostate cancer who are less than 65 years of age and have a life expectancy of more than 15 years, it is arguable that observation i.
Neither AS nor WW is regarded as a form of treatment in the sense that other therapies set out to 'cure' the cancer. However, it may be a good option for some men who have an appropriate diagnosis.
Men most likely to have a suitable diagnosis for this option are those who have what the Brady Institute at Johns Hopkins Memorial Hospital has categorized as an "insignificant tumor", which they define as set out below.
There are other definitions of what is termed "low risk cancer" which are similar: Active surveillance has emerged as a viable option that should be offered to patients with low-risk prostate cancer.
More thanmen a year diagnosed with prostate cancer in the United States are candidates for this approach. If you are considering this option it may be of interest to read these: At a median follow up of about 8 years, absolutely no difference was observed in the mortality or the metastasis rate.
Most of the men in the studies are still on AS. As long ago as a lawyer who posted as Lorenzo Q Squarf wrote a series of amusing depending on your sense of humor posts to a website and became involved in discussion on the Internet about why Watchful Waiting was the best option for most men.
His website is no more - he went on his way, finding discussion of PCa 'boring' - and was last heard of in at the ripe old age of 79 when, after he published a book about his flying experiences, he provided a brief update.
To get a taste - and some intelligent thinking - on the subject of Watchful Waiting, part of his website has been saved. The question 'to treat or not to treat? Active surveillance is the logical choice for most men and the families that love them to make.
The potential serious consequences of the conventional treatment choices are avoided. There is a possibility of spontaneous regression. It is difficult to even begin to estimate the probability of this occurring. This may be because of the "hit and miss" nature of biopsy procedures.
Negative consequences of active surveillance: The monitoring process chosen might not identify disease progression early enough and late intervention may be less effective than early intervention.
There is a possibility of the initial diagnosis being incorrect because the diagnostic tools used at present are not very accurate. Most protocol for AS require repeat biopsy procedures which carry a small degree of risk. Some of the problems associated with aging, such as an increase in BPH Benign Prostate Hyperplasiamay create urinary bothers such as increasing frequency, nocturia and the like.
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