For many men with prostate cancer, the process of watchful waiting – sometimes known as active surveillance – seems to be a strange way to treat the disease. After all, this process involves treating prostate cancer by, essentially, not treating it.
After your diagnosis, your first impulse may be to choose a surgical option to remove the cancer so that it is not longer an issue. However, surgery isn’t an option for all men and may not be the best means of treating prostate cancer.
Why Choose Watchful Waiting?
Prostate cancer comes with many misconceptions. One is that it is an extremely deadly disease that should immediately be removed from the body.
While it is the second leading cause of cancer death in American males, most men will not die from prostate cancer. ¹
In fact, according to the American Cancer Society, 1 in 7 men will be diagnosed with the disease at some point in their lives, yet only 1 in 38 men will die from prostate cancer.
The reason doctors recommend active surveillance as a course of treatment is simple: most prostate cancer grows so slowly that immediate action is not necessary and may cause more anxiety and stress.
How does it work?
While the process of active surveillance does not involve the removal of the prostate gland or cancerous tissue, it isn’t exactly a “hands off” approach, either.
After your cancer is diagnosed, your doctor will schedule regular visits in which your cancer will be monitored. Prostate specific antigen tests, digital rectal exams and biopsies are all means of monitoring your cancer’s growth rate. ²
A PSA test monitors the level of prostate-produced proteins in your blood. If your PSA levels spike quickly, this could indicate prostate cancer growth.
A digital rectal exam allows doctors to check for changes in the lower intestine or colon. A doctor will insert a gloved finger into the anus to feel for any abnormalities in the intestine, rectum, or bladder. Because the prostate gland is located below the bladder and in front of the rectum, it can easily be felt during a digital rectal exam. Changes in size, shape or density can all indicate the presence of cancer.
In some cases, biopsies may be performed to test the prostate tissue for any changes. During a biopsy, a needle is used to collect tissue from the prostate gland. These tissue samples are then taken to a lab, where they are monitored for cellular abnormalities.
When used alone, these tests cannot give an accurate cancer prognosis; however, when combine these tests are able to provide the doctor with an accurate overall picture of how your cancer is growing and which additional courses of treatment are necessary. ³
Problems with this treatment?
As with any form of treatment, watchful waiting has its problems.
Watchful waiting has very few physical side effects. There is always a slight risk of infection when undergoing a biopsy, but lifestyle-affecting side effects such as impotence and incontinence do not occur with this type of treatment. ⁴
The most glaring problem with active surveillance is perhaps the fact that you need to attend regular follow-ups or your doctor will not be able to accurately monitor the changes of the cancer.
While this does not seem like it would be an issue, according to a study conducted by members of the European Association of Urology, of 157 men undergoing watchful waiting treatment, 27% chose not to return to the doctor for checkups.
According to this study, these numbers are worse for men in the United States, who may face socio-economic barriers to doctor’s visits, such as being unable to afford the insurance copays of regular visits. ⁵
The lack of follow-up in patients is alarming, because doctors are unable to see how the cancer is growing and are unable to pre-emptively treat rapidly growing cancer. This can contribute to the development of advanced-stage prostate cancer and prostate cancer-related deaths.
Additionally, the mental and emotional strain of regular doctors visits could take their toll. The anxiety of waiting to find out the results of regular biopsies, PSA tests and DREs can make it seem as though your cancer has taken over your life. To many men, active surveillance treatment feels as though they aren’t doing enough to fight their cancer.
Learning that your cancer has grown and requires additional treatment can also cause emotional strain in men. If your doctor recommends watchful waiting treatment, speaking to a professional may help alleviate the stress and anxiety associated with this type of treatment program. ⁶
Watchful Waiting and Life Insurance
Finding a life insurance policy while undergoing active surveillance treatment may not be as difficult as you might assume.
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You will need to be sure to regularly follow up with your doctor and to closely follow your recommended treatment program.
With watchful waiting, obtaining affordable life insurance coverage boils down to organization: making sure your medical records are consistently updated and that you are regularly reporting any changes in your health to the insurance company.
While this type of treatment is not without risks, most insurance companies will view this as a less risky course of treatment than radiation or prostatectomy surgery. Typically men who undergo this type of treatment have low-grade, slow growing cancers and are unlikely to experience negative cancer-related health impacts.
However, watchful waiting can be confusing when shopping for life insurance because the possibility for cancer growth could potentially negatively affect your premiums.
If watchful waiting has been recommended as a treatment to monitor the possibility of cancer recurrence after surgery, be sure to communicate your last treatment and your doctor’s prognosis on the medical portion of your insurance application. This will allow underwriters to better gauge your risk.
To ensure that you lock in coverage at an affordable rate, you should work with an independent agent who understands how underwriters assess risk.
Our agents are knowledgeable about the risks of watchful waiting, as well as prostate cancer, and can communicate these risks favorably to underwriters.
Speak to an agent today or fill out an instant quote form to see how we can help you find affordable life insurance coverage.
- Expectant management, watchful waiting, and active surveillance for prostate cancer. (2014, January 1). http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-treating-watchful-waiting
- Anna Bill-Axelson, A., Holmberg, L., & Ruutu, M. (2002, January 1). Radical Prostatectomy vs Watchful Waiting in Early Prostate Cancer. http://www.medsch.ucla.edu/AngelUploads/Content/0506-UCLA-YEAR2-SURGC07-1/_assoc/2C57E767165D4575A66CE813CA5E3701/Bil-Axelson_NEJM_2005.pdf
- Choosing ‘Watchful Waiting’ for Prostate Cancer. (2012, July 23). http://well.blogs.nytimes.com/2012/07/23/choosing-watchful-waiting-for-prostate-cancer/
- Smilow Comprehensive Prostate Cancer Center. (n.d.). http://prostate-cancer.med.nyu.edu/treatment/watchful-waiting-and-active-surveillance
- HealthDay, W. (n.d.). Quarter of Prostate Cancer Patients May Abandon ‘Watchful Waiting’ Approach – WebMD. http://www.webmd.com/prostate-cancer/news/20140417/quarter-of-prostate-cancer-patients-may-abandon-watchful-waiting-approach
- Urology at UCLA. (n.d.). http://urology.ucla.edu/body.cfm?id=246