Active surveillance and watchful waiting for prostate cancer

Your doctor might use active surveillance or watchful waiting to monitor your prostate cancer. This means that you don’t have treatment straight away. 

Ways to monitor prostate cancer

There are 2 ways of monitoring prostate cancer:

• active surveillance
• watchful waiting

Active surveillance

Some prostate cancers are slow growing and might never cause you problems.

Your doctor might suggest waiting and seeing whether the cancer develops. This is instead of giving treatment straight away. All cancer treatments have side effects. So active surveillance can help make sure you don't have treatment that you don't need.

You have regular tests to check whether the prostate cancer is staying the same size or starting to grow. You can start treatment if there is any sign that your cancer is beginning to change or grow.

You have regular hospital appointments and tests. At each appointment, your doctor asks if you have developed any new symptoms.

Who has active surveillance?

You might have active surveillance if:

• your cancer is contained in the prostate gland - this is localised prostate cancer

• you have a Cambridge Prognostic Group of 1, 2 or 3

• you can have treatment that aims to cure if the cancer starts to grow

Your doctor will discuss the possible benefits and risks of active surveillance. They make sure that you're happy with whichever decision is made. 

What happens during active surveillance?

What happens during active surveillance depends on your local hospital. Your team can tell you more about what will happen. Below we have just one example of what might happen during year one of active surveillance. You may have a:

• blood test to monitor your PSA level every 3 to 6 months

• prostate examination at 12 months - you may not need this if you are having an MRI scan

• MRI scan

This is what may happen in year 2 and every year until active surveillance ends. You have a:

• blood test to monitor your PSA level every 3 to 6 months

• prostate examination - you may not need this if you are having an MRI scan

• MRI scan every 2 years

Many hospitals make you an individual plan for active surveillance. This depends on the chances that your particular prostate cancer may progress. Doctors call this risk stratified active surveillance. Speak to your medical team to see if they use such a system in your hospital.

Your doctor might recommend you have treatment if tests show your cancer is starting to grow. And if they think treatment would be a better option for you. The treatment aims to cure your cancer. Treatment is usually surgery to remove the prostate gland or radiotherapy.

Watchful waiting

Some prostate cancers grow very slowly. So in your lifetime, you might never need treatment. With watchful waiting you also have some tests. This helps your doctor decide if you need treatment. This follow up is usually at your GP surgery rather than at the hospital. You can discuss with your doctor how often you need tests.

Who has watchful waiting?

You might have watchful waiting if your cancer is contained in the prostate gland and you:

• have other health problems so you can’t have treatment to try to cure your cancer

• don’t want to have treatment to try to cure your cancer

• are diagnosed at an advanced age and your natural life expectancy means it's unlikely you will ever need or benefit from treatment

What happens during watchful waiting?

You have blood tests to measure your PSA levels. You usually have this at least once a year. Your GP can arrange for you to see a prostate cancer specialist if you have:

• a sudden rise in your PSA level
• develop any new symptoms, such as bone pain

Your prostate cancer specialist might recommend hormone treatment. The treatment aims to shrink and control your cancer rather than cure it.

Coping with active surveillance and watchful waiting

It can be hard to hear that you have cancer but not have treatment. You might feel worried that you aren't doing anything to stop the cancer. Or you might feel like the doctors are keeping treatment from you. Waiting for test results and check ups can also be difficult.

We have a general page of information for people who have cancer, but do not need treatment straight away.

Treatments for prostate cancer

We have information about the different treatments for prostate cancer.