What does watchful waiting
involve?
If you decide to have watchful waiting you will not have any
treatment for your prostate cancer. Your doctor or nurse will
normally ask your GP to give you a prostate specific antigen (PSA) blood test
every four to 12 months. This will give them a good idea about any
changes to your prostate cancer. You may also have digital rectal examinations (DRE) and other blood
tests and urine tests, although this will vary. Some men may have
these tests in the hospital. You will not usually need to have a prostate biopsy, which involves taking small
pieces of prostate tissue to look at more closely under a
microscope for signs of prostate cancer.
If any changes are picked up on these tests or you have any new or
different symptoms then your GP may refer you to see the doctor or
nurse at the hospital.
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What should I look out for
while I am on watchful waiting?
You should let your GP or doctor or nurse at the hospital know
if you have any symptoms or changes to your health. Things to look
out for include:
- changes to your urinary habits, for example blood in your urine
and problems passing urine
- changes to your bowel habits
- new problems with erections
- new aches and pains in your back or bones
- new swelling in your legs.
If you start getting any of these symptoms you may need to have
some further tests to see if your cancer has spread and you may be
offered treatment. The most common treatment to help improve these
symptoms is hormone therapy, as it shrinks the
cancer cells, wherever they are in the body.
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What is the difference
between watchful waiting and active surveillance?
Watchful waiting and active surveillance are both ways
of monitoring prostate cancer and avoiding immediate treatment.
However, there are some differences, including:
- who may be suitable for each approach
- what kind of tests you will have and how often you will have
them.
Active surveillance usually involves more regular hospital
tests, such as prostate biopsies. The aim is
to treat the cancer quickly if it shows signs of changing and to
try and get rid of it completely. Active surveillance is suitable
for men with cancer that is contained within the prostate gland (localised prostate cancer),
who are likely to be fit enough to have treatment such as surgery
or radiotherapy.
Watchful waiting usually involves check-ups at the GP surgery
rather than at the hospital. Check-ups usually happen less often
than with active surveillance. The aim is to treat the cancer if it
starts causing problems or symptoms. And treatment aims to control
the cancer rather than getting rid of it completely.
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What are the advantages
and disadvantages of watchful waiting?
What might be an advantage for one person may not be for someone
else. You can speak to your doctor or nurse about your own
situation and the things that are important to you.
Advantages
- As watchful waiting does not involve having treatment you will
avoid the physical side effects of treatment and you should be able
to enjoy your normal life and activities.
- You will not need to have invasive tests such as regular
prostate biopsies.
- Some men may never need treatment at all.
Disadvantages
- Some men may become anxious or worry about their cancer
changing and the possibility of developing symptoms. Partners and
family also often worry about their loved one and find it hard to
understand why they are not having treatment.
- There is a chance that the cancer may grow and change more
quickly than expected. If this happens you can start treatment such
as hormone therapy to control the cancer.
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Making a decision
Your doctor or nurse should discuss all the treatment options
that are suitable for you. They will take your age into account,
but should also consider other factors. For example you may be an
older man, but in good health and feel that you would benefit from
treatment. If you would like to discuss treatment but do not feel
you have been given this chance, let your doctor or nurse know that
you want to discuss it.
Your personal feelings and preferences are important. Some of these
suggestions may help with expressing your wishes.
- Take our booklets and leaflets into your appointment with you ,
as a way to talk things through with your doctor or nurse
- Write down any questions you want to ask before your
appointment
- Take a relative or friend into the appointments with you.
- Speak to one of our specialist nurses by calling our
confidential Helpline.
- Get further advice from the Patient Advice and Liaison Service
(PALS) or if you live in Scotland, the Scotland Patients
Association. Age UK offer support to older people
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What if I change my mind?
If you are having watchful waiting, but want to discuss other
options for managing your prostate cancer contact your GP or your
doctor or nurse. They should discuss whether there are any other
treatments that are suitable for you.
You can ask your doctor or nurse for an opinion about your
treatment from a different doctor (a second opinion). Although you
do not have a legal right to a second opinion, most doctors are
happy for you to have one and will refer you to a different
doctor.
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What support is
available?
If you are feeling worried or anxious it may help to talk to
family or friends about how you are feeling. You could also speak
to your doctor or nurse or call our confidential
Helpline.
You may be able to get support through support groups, our one-to-one peer support
service or our online
community.
If you are a partner, family member or friend of a man affected
by prostate cancer then you may also need some support - all the
services mentioned here are also open to you.
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What can I do to help
myself?
- If you have other health problems make sure that these are
being treated. Ask for a review of your medications or a general
check-up at your GP surgery
- Eating a healthy diet will benefit your overall health and
reduce your risk of other health problems. There is some evidence
that certain foods may slow down the growth of prostate cancer or
reduce the risk of it returning after treatment
- Physical activity is important for your general well-being and
can help with feelings of anxiety or depression, it is not clear
whether exercise can help to slow down the growth of prostate
cancer.
Find out more about healthy eating and physical activity in our
section on diet, physical activity and
prostate cancer.
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Questions to ask your
doctor or nurse
- Other than watchful waiting, what treatments would be suitable
for me?
- Why is watchful waiting suitable for me?
- What if I change my mind?
- How often will I need to have a PSA test?
- Will I need any other tests?
- Will I have appointments at the hospital or at my GP
surgery?
- What signs and symptoms should I look out for?
- If I develop any new symptoms who should I contact?
- If I need to start treatment, such as hormone therapy, what
will this involve?
- What else can I do to improve my overall health and
wellbeing?
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References
You can find a full list of references used to produce this page
in our online fact sheet.
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