Recent studies in the United States have shown that watchful waiting creates a longer life expectancy (survival of 10 to15 years) in those with prostate cancer than those that have undergone curative intent therapy. Any aggressive treatment can lead to incontinence, erectile dysfunction, bowel dysfunction, reduced life expectancy, increased morbidity and mortality. There are personal, marital and cultural factors involved as well when considering these treatment options.

Patients with localized prostate cancer have a favorable outlook following watchful waiting. The number of deaths related to radical initial treatment are potentially avoidable. Without reliable prognostic indicators, an aggressive approach to all patients with early disease would entail substantial over treatment. In contrast, patients with locally advanced or metastatic disease need trials of aggressive therapy to improve their poor prognosis.

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