Indeed, prostate cancer discovered when the patient is over 80 years of age tends to be slow growing, and is usually observed or watched, and treated only if the cancer seems to be growing aggressively. There are many physicians who do not screen or obtain PSA examinations routinely on patients over 80. If the digital rectal exam is stable there may not be an indication to do so. Similarly, patients with other severe medical conditions who are discovered to have prostate cancer may be best observed, and treated only if the prostate cancer is aggressive. Careful medical evaluation and discussion is indicated.
Prostate cancer seems to become higher grade with time.
There is no good protocol. At the minimum, PSA and digital rectal examinations should be done every three to six months. The decision to observe younger patients with prostate cancer must be made by an insistent, informed patient, who understands that he may not be curable if and when he desires to change his mind.