I have cut and pasted part of a post I recently included in another thread. Dr. Ballentine Carter of Johns Hopkins is the doc that runs this program. These are some very good guidelines as to whether to consider watchful waiting...
Re the issue of "watchful waiting", "active surveillance" or, as Johns Hopkins references it, "expectant management", had I had the right stats I would have chosen that course. I didn't and don't regret choosing treatment. Re Tony's comment about John being too general, here are some specific guidelines from Johns Hopkins for patients they allow into there "expectant management" program:
1. Age 60+.
2. T1C, i.e. nothing felt on DRE.
3. PSA density of .1 or less (this is PSA divided by size of prostate, e.g. PSA of 3 divided by prostate size of 35cc equals PSA density of .086 which is less than the .1 threshhold.
4. Gleason 6 or less.
5. 2 or fewer cores of cancer.
6. No core with more than 50% cancer involvment.
So, you can see that these requirement eliminate most of us. In other words, only older men with VERY early state PCa are suggested to consider "expectant management". However, for those that do, they undergo frequent PSA testing and biopsies and, as John mentioned, only a small percentage require treatment after 3 years. Hence, these men don't get "overtreated". To take this approach, however, DOES require a mindset of living with cancer, something many men cannot do, hence their urgency to "get it out". Those men may indeed be "overtreated", but it's because of their own decision making not because they took a PSA test...