Watchful waiting is a way of monitoring prostate cancer that is not causing any symptoms or problems. The aim is to monitor the cancer over the long term because prostate cancer is often slow growing and may not cause you any problems or symptoms in your lifetime. ^{1 2}

If you choose watchful waiting, you will not start treatment until you get symptoms, such as problems passing urine or bone pain. If your prostate cancer does cause symptoms then you are likely to be offered a type of treatment called hormone therapy to help manage these.

Watchful waiting may be suitable for you if: your prostate cancer is not currently causing you any symptoms or problems, and:
• you have other health conditions so may not be fit enough for treatment such as radiotherapy or surgery, or
• you are an older man and your prostate cancer may not ever cause you any problems in your lifetime or shorten your lifespan.

Treatments for prostate cancer like radiotherapy or surgery (radical prostatectomy) can cause side effects such as problems with erections, problems passing urine and bowel problems. For some men these side effects may be long term and may have a significant impact on their quality of life. If you decide to go on watchful waiting you will avoid the side effects of treatment.

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.

To find out more about these tests you can read our Tool Kit fact sheet, How prostate cancer is diagnosed.

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.

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.

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.

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 ^{3 4} 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.⁵
• There is a chance that the cancer may grow and change more quickly than expected. ^{6 7 8 9 10 11} If this happens you can start treatment such as hormone therapy to control the cancer.

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.

Some men are happy to avoid treatment, but other men may find it difficult and feel worried or anxious. ^{14 15} 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.
Some people find that it helps to talk to other men with prostate cancer. There are prostate cancer support groups throughout the country. Find details of your nearest group here, or by calling our Helpline, or by asking your doctor or nurse.

We can also arrange for one of our trained volunteers with personal experience of prostate cancer to speak to you through our one-to-one support service.

You may also like to sign up to The Prostate Cancer Charity online community, where you can share your views and experiences with others affected by prostate cancer.

Read our booklet, Living with and after prostate cancer: A guide to physical, emotional and practical issues for more information about getting emotional support.

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.

Your general health
If you have other health problems make sure that these are being treated. You could ask for a review of your medications or a general check-up at your GP surgery.

Diet
We need more research to show clearly how diet can help men who have been diagnosed with prostate cancer. ^{16 17} But a healthy diet will benefit your overall health and reduce your risk of medical problems such as heart disease and diabetes. There is some evidence that certain foods may slow down the growth of prostate cancer or reduce the risk of it returning after treatment.^{18 19}

Physical activity
It is not clear whether exercise can help to slow down the growth of prostate cancer. ^{20 21} But keeping active is important for your general health and wellbeing and can help you cope with feelings of anxiety or depression.²⁰

For more information and tips on healthy eating and exercise read our page on Diet, exercise and prostate cancer.

Age UK
www.ageuk.org.uk
0800 169 6565 (8am-7pm, Mon-Fri)
Information or advice for older people on anything from health to housing,

Patient Advice and Liaison Service (PALS)
www.pals.nhs.uk
For information about resolving concerns or problems when you are using the NHS and the NHS complaints procedure. You can find you local PALS office by going online or asking at your local hospital.

Macmillan Cancer Support
www.macmillan.org.uk
Freephone Cancerline 0808 808 2020 (9am-9pm, Mon-Fri)
For support and information about cancer.

Scotland Patients Association
www.scotlandpatients.com
0141 942 0376 (9.30am-4.30pm, Mon-Fri)
Provide support and information to patients in Scotland. Can advise patients who feel they have received inadequate or inappropriate health care.

• 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?

• Bev Baxter, Urology Oncology Nurse Specialist, Royal Derby Hospital, Derby
• Susan Forbes, Prostate Cancer Nurse Specialist, Torbay Hospital, Torquay
• Chris Parker, Consultant Clinical Oncologist, Institute of Cancer Research and Royal Marsden Hospital, Sutton
• Evelyn Pearson, Urology Nurse Specialist, Stockport NHS Foundation Trust, Stockport
• Anup Patel, Consultant Urological Surgeon, Imperial College, London
• Prostate Cancer Voices
• The Prostate Cancer Charity Support & Information Specialist Nurses

1. Albertsen PC, Hanley JA, Fine J. 20-Year outcomes following conservative management of clinically localized prostate cancer. The Journal of the American Medical Association 2005;293(17): 2095-2101.

2. O' Donnell H, Parker C. What is low-risk prostate cancer and what is its natural history. World Journal of Urology 2008;26:415-422. [DOI: 10.1007/s00345-008-0277-9

3. Wallace M (2003) Uncertainty and quality of life of older men who undergo watchful waiting for prostate cancer. Oncology Nursing Forum 30, 303-309.

4. Bailey D, Mishel M, Belyea M, Stewart J, Mholer, Clark J (2004) Uncertainty intervention for watchful waiting in prostate cancer. Cancer Nurs 27: 339-346

5. Chapple A, Ziebland S, Herxheimer A, McPherson A, Shepperd S, Miller R.
Is 'watchful waiting' a real choice for men with prostate cancer? A qualitative study. BJU Int. 2002 Aug;90(3):257-64.

6. British Uro-oncology Group (BUG), British Association of Urological Surgeons (BAUS): Section of Oncology, British Prostate Group (BPG). )MDT (Multi-disciplinary Team) Guidance for Managing Prostate Cancer 2nd Edition (November 2009)

7. Walsh PC. Immediate versus deferred treatment for advanced prostatic cancer: initial results of the Medical Research Council trial. The Medical Research Council Prostate Cancer Working Party Investigators Group. J Urol 1997 Oct;158(4):1623-4.http://www.ncbi.nlm.nih.gov/pubmed/9302187 46

8.The Medical Research Council Prostate Cancer Working Party Investigators Group. Immediate versus deferred treatment for advanced prostatic cancer: initial results of the Medical Research Council Trial. Br J Urol 1997 Feb;79(2):235-46.

9. Chodak GW, Thisted RA, Gerber GS, Johansson JE, Adolfsson J, Jones GW, Chisholm GD, Moskovitz B, Livne PM, Warner J. Results of conservative management of clinically localized prostate cancer.N Engl J Med 1994 Jan;330(4):242-8.

10. Albertsen PC, Hanley JA, Gleason DF, Barry MJ. Competing risk analysis of men aged 55 to 74years at diagnosis managed conservatively for clinically localized prostate cancer. JAMA 1998Sep;280(11):975-80.http://www.ncbi.nlm.nih.gov/pubmed/9749479

11. Albertsen P, Hanley JA, Murphy-Setzko M. Statistical considerations when assessing outcomes following treatment for prostate cancer. J Urol 1999 Aug;162(2):439-44.

12. National Institute for Health and Clinical Excellence. 2008. Prostate cancer: diagnosis and treatment. Available at http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11924

13. NHS Constitution. Available at: http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Pages/Overview.aspx

14. Wallace M (2003) Uncertainty and quality of life of older men who undergo watchful waiting for prostate cancer. Oncology Nursing Forum 30, 303-309.

15/ Bailey D, Mishel M, Belyea M, Stewart J, Mholer, Clark J (2004) Uncertainty intervention for watchful waiting in prostate cancer. Cancer Nurs 27: 339-346

16. World Cancer Research Fund/American Institute for Cancer. Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective. Washington DC:AICR, 2007

17. Ma RW-L, Chapman K. A systematic review of the effect of diet in prostate cancer prevention and treatment. Journal of Human Nutrition and Dietetics. 2009; 22:187-99.

18. Van Patten CL, de Boer JG & Tomlinson Guns ES. Diet and dietary supplement intervention trials for the prevention of prostate cancer recurrence: A review of the randomized controlled trial evidence. The Journal of Urology. 2008; 180:2314-22.

19. Chan JM, Holick CN, Leitzmann MF et al. Diet after diagnosis and the risk of prostate cancer progression, recurrence, and death (United States). Cancer Causes Control. 2006;17(2):199-208.