Conflicting insights into the role of watchful waiting in the management of adenocarcinoma of the prostate.

Approximately 20% to 30% of men undergoing prostate-specific antigen (PSA) testing in referral and screened populations will have well- to moderately differentiated (Gleason score ≤ 6) and small volume (< 0.5 cm3) tumors. These tumors are thought to be less significant than larger, higher-grade tumors and demonstrate a long natural history.1–3 Expectant management of prostate cancer is based on the assumption that therapy (as well as potential complications) in these patients can be deferred without adverse consequence until it is no longer necessary (patient becomes old enough that prostate cancer is unlikely to be the cause of mortality) or until changes in the characteristics of the tumor warrant immediate treatment. Expectant management can be an active curative treatment approach if patients are treated aggressively upon follow-up determination of pathological progression.2,4 The results of two important studies with differing conclusions regarding the expectant management of localized prostate cancer have recently been released.