<p><strong> </strong><strong>In asymptomatic patients with prostate cancer and limited life expectancy (determined on a patient-specific basis), clinicians should recommend watchful waiting. <em>(Strong Recommendation; Evidence Level: Grade A)</em></strong></p>
Discussion
Discussion
<p>Patients with a life expectancy of ≤5 years do not benefit from prostate cancer screening, diagnosis, or treatment<sup>134</sup> as prostate cancer treatment does not improve survival within five years of follow-up.<sup>135</sup> The PIVOT and SPCG-4 randomized trials of radical prostatectomy versus observation/watchful waiting collectively demonstrate the relative importance of competing risks of mortality and of patient longevity (minimum estimated life expectancy of 8-10 years) in order for treatment to result in a reduction in the risk of death.<sup>136, 137</sup></p>
<p>Watchful waiting does not involve routine cancer surveillance but rather aims to deliver palliative therapy for relief of symptoms should they develop. The critical goal of watchful waiting is to maintain the patient’s QOL by avoiding treatment when prostate cancer is unlikely to cause mortality or significant morbidity. One of the principal aims of watchful waiting is avoidance of side effects from local treatment or ADT. Watchful waiting is appropriate for elderly patients or patients with significant comorbidities in whom competing risks of mortality are considerably greater than the risk of death from prostate cancer.</p>
<p>The Panel acknowledges that life expectancy is difficult to predict and notes the existence of several predictive tools to help with this assessment, such as the Kent model.<sup>138</sup></p>