Active Surveillance (Watchful Waiting) for Prostate Cancer

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Active Surveillance (Watchful Waiting) for Prostate Cancer

Treatment Overview

Active surveillance (watchful waiting) is a good treatment choice for men who have prostate cancer that is low-risk and not likely to spread (early stage). Whether this is a good choice for you is something you will want to discuss with your doctor. Together you and your doctor will want to consider:

  • Your life expectancy.
  • The stage and Gleason score of your cancer.
  • Your general health.
  • The possible side effects you might have from other treatments.

Your personal preference needs to be part of this decision.

With active surveillance, you and your doctor will watch your cancer closely to see if it causes any symptoms or appears to be growing. During this time, you will have checkups and tests, such as PSA tests and digital rectal examinations. You may also have prostate biopsies.

It may seem odd to have cancer and not have surgery to remove it or radiation therapy to kill the cancer. But unlike many other cancers, most prostate cancer grows very slowly. Slow-growing prostate cancer does not normally cause symptoms, so it is possible to have prostate cancer for years without ever knowing it.

Prostate cancer treatments like surgery, radiation, and hormone therapy have serious side effects. These side effects include bladder, bowel, and erection problems. With active surveillance, men who have low-risk prostate cancer can wait to start other treatment. Some men will never need more treatment. And others can delay dealing with any side effects until tests show their cancer is growing more quickly.

If you choose active surveillance, you are taking a chance that your cancer will spread and become incurable during that time. But this is not common. Regular checkups will increase your chances to find out right away if your prostate cancer grows. That way your cancer still can be treated in the early stages, when treatments are more successful.

Active surveillance may mean not having treatment to cure the cancer even if it grows. Some men choose not to have any treatment because they have another medical condition, such as a heart condition or diabetes. Or they may only have a short time to live. Either way, they may not be strong enough for treatments such as surgery or radiation. These men may choose to only have treatments to stay comfortable.

Unless you only have a short time to live, if your prostate cancer is faster-growing (higher-grade), your doctor probably will recommend other treatments. Each type of prostate cancer treatment has its pros and cons. And it is important that you and your doctor think about both when making your treatment decisions.

What To Expect After Treatment

Active surveillance sometimes continues for years. In other cases, tests eventually show that the cancer is growing and needs to be treated.

Why It Is Done

Prostate cancer is typically a slow-growing cancer. In the United States, about 17 out of 100 men will get prostate cancer, only 3 of these 17 will die of prostate cancer. That means that 97 out of 100 of these men will die of something other than prostate cancer.1

If your cancer is caught before it has spread and it is a low-grade or slow-growing cancer, you may choose active surveillance rather than surgery or radiation. With active surveillance, men who have low-risk prostate cancer can wait to start treatment. Some men will never need treatment. And others can delay dealing with these side effects until tests show their cancer is growing more quickly.

How Well It Works

Men who have newly diagnosed and slow-growing prostate cancer may choose to take a little time to make their decision about treatment.

Active surveillance appears to work as well as prostatectomy and radiation therapy for most men over 65 who have early-stage prostate cancer (stages I and II, also called localized prostate cancer). For men younger than 65, treatment with surgery may help them live longer.2


The main reason to choose other treatment (and not active surveillance) is to not miss the chance of being cured. With active surveillance, there is still a small chance that the cancer may grow quickly and spread.

Of course, even with surgery or radiation, there is a small chance that the cancer will spread. But after the cancer spreads, the treatment to get rid of it may be more complicated and cause more side effects. In some cases, it may be more difficult to have nerve-sparing surgery.

What To Think About

When prostate cancer is discovered very early because of a PSA test, symptoms usually do not appear for at least 10 years. This means that if your prostate cancer is small and slow-growing, you may have a few years to decide about starting treatment. Or you may decide to continue with active surveillance.

Early prostate cancer does not usually cause symptoms, but some men do have problems urinating. If you are having symptoms and have not yet had treatment, this is a time to talk to your doctor about treatment.

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  1. Zelefsky MJ, et al. (2008). Cancer of the prostate. In VT DeVita Jr et al., eds., Devita, Hellman, and Rosenberg's Cancer: Principles and Practice of Oncology, 8th ed., vol. 1, pp. 1392–1452. Philadelphia: Lippincott Williams and Wilkins.
  2. Lu-Yao GL, et al. (2010). Outcomes of localized prostate cancer following conservative management. JAMA, 302(11): 1202–1209.


By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer J. Curtis Nickel, MD, FRCSC - Urology
Last Revised September 27, 2010

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