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Monitoring prostate cancer

Monitoring means that your treatment team keep a close eye on you. You don't have any treatment straight away. Your doctor monitors you with regular tests, to see whether your prostate cancer is staying the same or starting to grow. You can start treatment straight away if there is any sign that you need to.

Active surveillance

You may have active surveillance if you are diagnosed with localised prostate cancer that may never need treatment. Localised prostate cancer means that the cancer is contained completely within the prostate gland. Active surveillance means that you usually go to the hospital for regular appointments. 

You have blood tests every few months to monitor your levels of a protein called prostate specific antigen (PSA). You also have regular digital rectal examinations. After the first year of surveillance you have samples of prostate tissue (biopsies) taken. If any of these tests show that the cancer is starting to grow, your doctor will advise you to have treatment. They may recommend either surgery to remove the prostate gland or radiotherapy. Some people have hormone therapy as well as radiotherapy. These treatments aim to try to cure your prostate cancer. 

Watchful waiting

Doctors use watchful waiting for locally advanced or metastatic prostate cancer that has grown too far to cure but is not causing symptoms. Locally advanced cancer means that the cancer has spread outside the prostate gland. Metastatic prostate cancer means the cancer has spread to other parts of the body. 

Watchful waiting may also be used if you have prostate cancer that is completely contained within the prostate but causing no symptoms and you have other medical problems that mean you can't have surgery or radiotherapy.

Generally, watchful waiting involves fewer tests than active surveillance. You still have regular appointments, blood tests and rectal examinations. But you are less likely to have regular prostate biopsies.

 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating prostate cancer section.

 

 

What monitoring is

Monitoring means that your treatment team keeps a close eye on you. You don't have any treatment straight away. Your doctor monitors you with regular tests. The tests check whether the prostate cancer is staying the same or starting to grow. You can start treatment straight away if there is any sign that your cancer is beginning to change or grow.

Your doctor may call monitoring prostate cancer either active surveillance or watchful waiting. Some doctors use these terms to mean the same thing. But they are actually used in different situations. So we have covered them separately on this page.

 

Why doctors use monitoring

Prostate cancer specialists use monitoring because some men with prostate cancer never need treatment. Prostate cancer is generally a disease affecting older men. Some prostate cancers develop quite quickly (over a few years) but most develop very slowly. We know from post mortems that most older men who have died from other causes also have signs of prostate cancer. They had not had any symptoms from the cancer and did not know they had it.

It is difficult for doctors to tell whether a prostate cancer is going to grow quickly or slowly. Blood tests and scans can now detect prostate cancer earlier and earlier. So when doctors diagnose a prostate cancer from tests, they may want to wait to see whether the cancer is going to develop, rather than giving treatment straight away. In this way, they can avoid unnecessary side effects that could seriously affect your quality of life.

All cancer treatment has side effects. Men may have immediate side effects when going through treatment and also long term problems after prostate cancer treatment. The side effects may include urine leakage (incontinence) or difficulty getting an erection (impotence). Obviously it is best to avoid these problems if at all possible.

The regular blood tests and checks during active monitoring mean that your doctors will pick up any growth of the cancer. Then you can have appropriate treatment if you need it.

 

The difference between active surveillance and watchful waiting

Some doctors use these terms as if they mean the same thing. But they are slightly different. Basically, you are having active surveillance if your doctor intends you to have radical treatment to try and cure your prostate cancer if it starts to grow.

Watchful waiting means keeping treatment to control prostate cancer in reserve, because you aren't having any symptoms. Either your cancer is locally advanced or metastatic and is likely to be too far grown to cure. Or you have other medical conditions that mean you are not fit enough for surgery to remove the prostate or radiotherapy to the prostate. Doctors keep treatment in reserve because you may never need it if your cancer does not cause you any problems. It can also help to control your prostate cancer for as long as possible. Prostate cancers can develop resistance to treatment so it is best not to start it before you have to.

 

Active surveillance

You may have active surveillance if you are diagnosed with localised prostate cancer that may never need treatment. Your specialist will take into account

  • Your PSA test results
  • How the prostate cancer cells look under a microscope (the Gleason score)
  • The size of your prostate gland
  • Your views about treatment

You usually go to the hospital for regular appointments. In the first year of active surveillance you have

In the 2nd to 4th years of active surveillance you have

  • Blood tests every 3 to 6 months to monitor your PSA levels
  • Digital rectal examinations every 6 to 12 months

In the 5th and following years of active surveillance you have 

  • Blood tests every 6 months to monitor your PSA levels
  • Digital rectal examinations every 12 months

At each appointment your doctors will also ask if you have developed any new symptoms. If you develop symptoms, or if your test results show that the cancer is starting to grow, you can either have surgery to remove the prostate gland or radiotherapy to the prostate to try to cure it.

UK Prostate Link can direct you to information about managing prostate cancer without active treatment.

 

Watchful waiting

You may have watchful waiting if you

Watchful waiting means keeping treatment to control prostate cancer in reserve, because you aren't having any symptoms. Generally, watchful waiting involves fewer tests than active surveillance. You will still have regular appointments, blood tests and examinations. But you are less likely to have regular prostate biopsies. Your doctor may suggest that you have a bone scan.

You can discuss with your doctor how often you need tests. Specialists recommend PSA testing at least every year. You may be able to have your monitoring at your GP surgery instead of having to go back to the hospital for every appointment.

If you develop symptoms, your specialist is likely to suggest hormone treatment to shrink and control the cancer.

 

How you may feel

Some people find it very stressful to know they have a cancer and not have any treatment straight away. Firstly, do talk to your doctor about what they are suggesting. Once you know what is being suggested, you can talk to your doctor about how you feel about monitoring. You may feel reassured when your doctor explains how often you will have checks. They can also tell you what the treatment options may be if the cancer starts to grow.

 

What you can do for yourself

During monitoring, there are some things you can do which may help to keep you healthy and will help you to feel you are doing something positive

  • Eat a healthy diet
  • Learn to relax if you can
  • Stop smoking – smoking can make it more likely that prostate cancer will grow quickly or come back after treatment
  • Take notice of any new symptoms and report them to your doctor

We know in general that a diet high in fresh fruit and vegetables and fish, and lower in animal fats is better for your health.

There is currently no hard evidence linking stress to cancer. But monitoring can be a stressful situation for some people and relaxation will help you feel better and probably cope better too. You could find a new hobby or try relaxation tapes. Libraries often have tapes they can lend to you.

Along with stopping smoking, making changes like these to your lifestyle will help you to feel more in control of your situation. You are taking positive steps to improve your health and that is a good thing.

 

More information about prostate cancer treatments

We have detailed information about the treatments for prostate cancer and their possible side effects. You can also phone the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday. They will be happy to answer any questions. 

Our prostate cancer organisations page gives details of other people who can give information about prostate cancer treatments. Some organisations can put you in touch with a cancer support group.

Our prostate cancer reading list has information about books, leaflets and other resources discussing prostate cancer treatments.

If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.

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Updated: 21 February 2014