My friend told me his treatment option for prostate cancer was “watchful waiting”, what exactly does this mean and why would he not seek other treatment options?

The concept of “watchful waiting” today is more correctly called “active surveillance”. Watchful waiting is an older concept where a patient takes no action in the treatment of their cancer until problems arise. Active surveillance, which is becoming more widely practiced, comes from the fact that in many men as they age small spots of prostate cancer develop that will never harm them in their lifetime (some times called “autopsy cancers”). Active surveillance involves monitoring a patient for any changes and then take action before the cancer can cause any harm. This is most commonly done for men with a 10 year life expectancy or less with less aggressive forms of prostate cancer. The assessment of aggressiveness is based on low Gleason scores (usually 6 or less), only small amounts of cancer on the biopsy specimen, and PSA levels of < 10 ng/dL. Part of most current active surveillance protocols include a periodic examinations, PSA levels and biopsy of the prostate to determine and changes in the nature of the cancer.