"Doing nothing is sometimes best treatment"

The Blade
by Michael Woods and Kevin Merrill
July 23, 2001

How would you describe a person who gets diagnosed with a disease, yet decides against taking any treatment?

Foolhardy? Irrational? Irresponsible? An informed medical consumer?

Surprisingly enough, "watchful waiting" sometimes can be good medicine for diseases ranging from a child's ear ache to cancer.

Watchful waiting does not mean ignoring symptoms and delaying a visit to the doctor for a diagnosis. Rather, it's a carefully orchestrated response to certain diseases that doctors sometimes term "expectant therapy."

Patients decide on watchful waiting after a diagnosis and full discussion of treatment options with the doctor. For serious diseases like cancer, there may be second or third opinions from specialists. Savvy health care consumers also research the topic themselves on the Internet and in the library.

The watch-and-wait approach for early prostate cancer in men has gotten a lot of recent attention. Here's the situation, described in an April report from the National Cancer Institute (NCI): If all men over age 50 had a prostate biopsy, 50 out of 100 probably would have some cancer cells. In almost 90 percent of those men, the cancer cells remain - in the report's term - "harmless." They never grow into tumors that cause symptoms or become life-threatening.

What's a man with early prostate cancer to do? Get treated with surgery or radiation? It would almost certainly eliminate the cancer. But treatment also may have side effects, including impotence. Or should the man wait and see if he's among the lucky majority without dangerous cancer?

Watchful waiting, however, also is used for other diseases.

Some pediatricians and family physicians, for instance, are using it for childhood ear infections. Instead of prescribing antibiotics immediately, they wait a few days to see if the infection clears up.

Watchful waiting long has been standard strategy for abdominal aortic aneurysms (AAAs). An AAA is a weak spot in the aorta, the major blood vessel that carries blood from the heart. Surgeons usually wait until the AAA reaches a certain size before repairing it.

It also may be used for certain other kinds of cancer, in addition to early prostate cancer.

In the watch-and-wait approach, the patient and doctor decide what will be watched, and what will be waited for.

They watch the disease to see if it remains the same or gets worse. The man with early prostate cancer, for instance, may get frequent PSA (prostate specific antigen) tests, watching for a rise in PSA that may mean the cancer is getting worse. The person with a AAA gets other tests to monitor the size of the aneurysm.

What do they wait for? Some sign that the disease is getting worse; a better treatment with fewer side effects; a cure, or a change in the patient's overall health that makes immediate treatment more or less important.

Patients should check on treatment while watching and waiting - treatment that may help keep the disease under control.

Studies, for instance, hint that vitamin E, selenium, and lycopene (a material found naturally in tomatoes and tomato products) can help prevent prostate cancer.

Check the Internet for information on this and other studies.

Is watchful waiting good medicine for you? Ask the doctor if it is an option. Get information about the risks and benefits. Apply it to your own situation.

Watchful waiting is not an easy option to pick. It clashes with the natural desire to take action and do something about a disease immediately. Sometimes, however, it's the best medicine.

Michael Woods is the Blade's science editor. Email him at

mwoods@theblade.com.

Kevin Merrill

Online editor

www.toledoblade.com

(419) 724-6047

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