Active surveillance and watchful waiting for prostate cancer

Your doctor might use active surveillance or watchful waiting to monitor you if you’ve been diagnosed with 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, rather than 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. This is similar to a low or medium risk localised prostate cancer
  • 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. This is typically what may happen during year one of active surveillance. You may have a:

  • blood test to monitor your PSA level every 3 to 4 months
  • prostate examination at 12 months. You may not need this if you are having an MRI scan
  • type of MRI scan called multiparametric MRI (mpMRI) at 12 months

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 called multiparametric MRI (mpMRI)

You have treatment if you develop any new symptoms, or if tests show your cancer is starting to grow. 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 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 you have localised prostate cancer 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

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.

Treatments for prostate cancer

We have information about the different treatments for prostate cancer. 

  • Prostate cancer: diagnosis and management
    National Institute for Health and Care Excellence (NICE), 2019. Last updated December 2021

  • Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow up
    C Parker and others
    Annals of Oncology, 2020. Vol 31, Issue 9. Pages 1119-1134

  • Northern Cancer Alliance Follow up guidelines for prostate cancer patients
    NHS Northern Cancer Alliance, 2020

  • Active surveillance for prostate cancer: a narrative review of clinical guidelines
    S M Bruinsma and others
    Nature Reviews Urology, 2016. Vol 13. Pages 151-167

  • Radical prostatectomy or watchful waiting in prostate cancer – 29 year follow up
    A Bill-Axelson and others
    The New England Journal of Medicine, 2018. Vol 379. Pages 2319-2329

Last reviewed: 
31 May 2022
Next review due: 
31 May 2025

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