Prostate Cancer

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 will have regular PSA tests and may have digital rectal examinations.

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. 

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. 

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.

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. In the first year of surveillance you will usually have blood tests every 3-4 months to monitor your PSA levels and  digital rectal examinations every 6 months, and will be asked if you have developed any new symptoms and after a year you will be asked to have a prostate biopsy. After the first year of surveillance you will usually have blood test every 3-6 months to monitor your PSA levels and a digital rectal examination every 6 months. After five years of surveillance blood test will usually be every 6 months and a digital rectal examination every 12 months (recommended by NICE CG175 January 2014).

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 March 2015.

Last updated March 2015.

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