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Active surveillance and watchful waiting

Your doctor might use active surveillance to monitor you if you’ve been diagnosed with prostate cancer. Watchful waiting is another way of monitoring your cancer.

What is monitoring your cancer?

Monitoring means you don’t have treatment straight away when you are diagnosed with prostate cancer. Instead, your doctor keeps a close eye on you.

This is because some cancers are slow growing and might never cause you problems.

Your doctor might want to wait and see whether the cancer develops, rather than giving treatment straight away. All cancer treatments have side effects. So monitoring your cancer can help to make sure you don't have treatment that you don't need and side effects.

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.

Ways to monitor prostate cancer

There are 2 ways of monitoring prostate cancer:

  • active surveillance
  • watchful waiting

What is active surveillance?

You have regular hospital appointments and tests. At each appointment your doctor will also ask if you have developed any new symptoms.

In year one of active surveillance you have:

  • blood tests to monitor your prostate specific antigen (PSA) levels – every 3 to 4 months
  • a prostate examination, where the doctor puts a gloved finger into your back passage to feel your prostate gland and check it's size and shape (digital rectal examination) – at 12 months
  • a more detailed type of MRI scan (mpMRI) - at 12 to 18 months 

In year 2 and every year until active surveillance ends you have: 

  • blood tests to monitor your PSA levels – every 6 months
  • a prostate examination (digital rectal examination) – every 12 months 

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.

Who has active surveillance

You might have active surveillance if:

  • your cancer is contained in the prostate gland (localised prostate cancer)
  • you have a low risk of the cancer growing AND you can have treatment that aims to cure you if the cancer starts to grow
  • you have a medium risk of the cancer growing AND you want to delay treatment that aims to cure you

Your doctor will discuss the pros and cons of active surveillance or having radiotherapy or surgery with you. They should always make sure that you're happy with whichever decision is made. 

What is watchful waiting?

Your tests and checkups usually take place at your GP surgery rather than at the hospital. You can discuss with your doctor how often you need tests.

You have a blood test to measure your prostate specific antigen (PSA) levels. You usually have this at least once a year.

Signs that your prostate cancer might be growing include:

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

If you develop any signs or symptoms, your doctor might organise further tests. They usually recommend hormone treatment. The treatment aims to shrink and control your cancer.

Who has watchful waiting

You have watchful waiting if:

  • you have prostate cancer that has spread (locally advanced or advanced cancer) with no symptoms
  • your cancer is contained in your prostate (localised cancer) but you have health problems so can’t have treatment to try to cure your cancer
Last reviewed: 
17 Jun 2019
  • Prostate cancer: diagnosis and management
    National Institute for Health and Care Excellence (NICE), 2019

  • EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent - update 2013
    A Heidenreich and others
    European Urology, 2014. Volume 65, Pages 124-37

  • Multi-disciplinary Team (MDT) Guidance for Managing Prostate Cancer
    British Uro-oncology Group (BUG) and the British Association of Urological Surgeons (BAUS) Section of Oncology, 2013

  • Long-term quality-of-life outcomes after radical prostatectomy or watchful waiting: the Scandinavian Prostate Cancer Group-4 randomised trial
    E Johansson and others
    Lancet Oncology 2011. Vol 12, Pages 891 – 899

  • Treatment choices for men with early stage prostate cancer
    National Cancer Institute booklet
     

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