Watchful waiting and active surveillance

Some prostate cancers are very slow growing and never cause the man any problem. This is particularly true with older men, many of whom will die from another condition before the cancer causes trouble. Because there is also considerable uncertainty about the effects of all of the available treatments for prostate cancer, 'watchful waiting', which involves frequent monitoring without active treatment, may be the best choice for some men.

Watchful waiting

Watchful waiting aims to avoid treatment unless symptoms develop. If a man does chose watchful waiting, active treatment may be pursued if symptoms become apparent or the cancer progresses. You may have regular PSA tests.

Some men were certain that watchful waiting was not an option they could have lived with. Also, not all men were aware that watchful waiting is considered to be a serious option for men with prostate cancer, perhaps because it is hard to believe that early aggressive treatment would not be most beneficial. One man's doctor told him that watchful waiting was not recommended for men of African descent. 

Concludes he could not have lived with watchful waiting.

Compares watchful waiting to naïve ignorance.

States that he was informed watchful waiting is not recommended for those of African descent.

Men who wanted to opt for watchful waiting could come under considerable pressure from well meaning members of their families, support groups or doctors, and commented that you might need to be quite strong to stick to the decision. 

Describes the pressure from family not to stay with watchful waiting.

Highlights the pressure from his consultant and wife to not continue with watchful waiting.

For men who chose watchful waiting the deciding factors were finding out about the uncertainty of benefits from active treatment; and avoiding the incontinence and impotence which are frequent side effects of treatment (see 'Side effects of treatments' section). For at least one man the disruption involved in daily radiotherapy treatment was also a factor. Those who had chosen watchful waiting had sought second opinions, spoken to doctors in the family and had seen a US video reviewing treatment options.

Concluded watchful waiting was more suitable for him, considering the problems with radiotherapy.

Concludes his decision to opt for watchful waiting stems from the uncertainty of benefits in active treatment. 

Active surveillance

Active surveillance is another form of observation for men with localised prostate cancer. In this case the doctor intends a man to have treatment to try and cure the cancer if it starts to grow. It is different from traditional watchful waiting in that the patient is more carefully observed. You will usually have blood tests every 1-3 months to monitor your PSA levels and frequent digital rectal examinations, and will be asked if you have developed any new symptoms. You may also have prostate biopsies every few years.

If these regular tests show that the cancer is progressing (growing) your doctors will then recommend treatment intended to cure the cancer, such as surgery or radiotherapy. If your cancer is not growing or developing, it is safe to continue with active surveillance.

Last reviewed January 2012.

Last updated October 2011.