Watchful waiting

Watchful waiting is a way of monitoring prostate cancer that isn't causing any symptoms or problems. The aim is to keep an eye on your cancer over the long term, and avoid treatment unless you get symptoms or signs that the cancer is growing.

Prostate cancer is often slow growing and may never cause any problems or symptoms. Many treatments for prostate cancer can cause side effects. For some men these side effects may be long-term and may have a big impact on their lives.

If you decide to go on watchful waiting, you’ll avoid these side effects as you won't have treatment unless your cancer starts to cause problems.

Many men on watchful waiting will never need any treatment for their prostate cancer. But for some men, their cancer may grow more quickly than expected and they may start to get symptoms, such as urinary problems or bone pain. If this happens, you can start treatment to control the cancer and improve your symptoms. 

Read about the other treatments that are available.

Download or order Watchful waiting fact sheet

What is the difference between watchful waiting and active surveillance?

Watchful waiting is often confused with active surveillance, which is another way of monitoring prostate cancer. The aim of both is to avoid having unnecessary treatment, but the reasons for having them are different. Check with your doctor which one you're being offered.

Watchful waiting

• If you do have treatment at any point, it will usually aim to control the cancer and manage symptoms, rather than cure it.
• It’s generally suitable for men with other health problems who may not benefit from treatment, such as surgery or radiotherapy, or whose cancer may never cause problems during their lifetime.
• It involves fewer tests than active surveillance. These check-ups usually take place at the GP surgery rather than at the hospital.

Active surveillance

• If you need treatment at any point, it will usually aim to cure the cancer.
• It is only suitable for men with slow-growing cancer that hasn't spread outside the prostate (localised cancer), and who would benefit from treatment, such as surgery or radiotherapy, if they needed it.
• It involves more regular hospital tests than watchful waiting, such as magnetic resonance imaging (MRI) scans and prostate biopsies.

Other terms you might hear

Some people use names such as ‘active monitoring’, ‘deferred therapy’, ‘watch and wait’ and ‘wait and see’ to describe both watchful waiting and active surveillance. These can mean different things to different people, so ask your doctor or nurse to explain exactly what they mean.

Who can go on watchful waiting?

Watchful waiting may be suitable for you if your prostate cancer isn’t causing any symptoms or problems, and:

• treatments may not be suitable for you because you have other health conditions, or because treatment may not help you live longer
• your prostate cancer isn’t likely to cause any problems during your lifetime, or shorten your life
• you do not want to have treatment.

It’s important that you discuss other treatment options with your doctor, and if you’re happy to go onto watchful waiting.

Can I have treatment instead of watchful waiting?

There will be treatment options available to you if you don’t want to go on watchful waiting. These will depend on whether your cancer has spread and how quickly it might be growing, as well as any other health problems you might have.

If at any time you decide that you want treatment, talk to your doctor or nurse about your options. They can explain your test results and discuss all your treatment options with you.

You can also chat to one of our Specialist Nurses.

You should have all the information you need before making a decision.

What are the advantages and disadvantages of watchful waiting?

What is important to one person may not be so important to someone else. Speak to your doctor or nurse about your own situation and the things that are important to you.

Advantages

• You’ll avoid the side effects of treatment while you’re on watchful waiting.
• You won’t need to have regular MRI scans or prostate biopsies.
• If you get symptoms, treatments such as hormone therapy or radiotherapy can help manage them. But many men never need any treatment.

Disadvantages

• There is a chance that the cancer may change and grow. If this happens you can start treatment such as hormone therapy to shrink the cancer and treat the symptoms. Treatment options such as hormone therapy can’t cure the cancer, but they can help keep it under control, sometimes for several years. 
• You might worry about your cancer growing and about getting symptoms. But men having treatment often have these worries too.
• Partners, family members or friends may worry about their loved one and find it hard to understand why they aren’t having treatment.

What does watchful waiting involve?

If you’re on watchful waiting you may have tests to monitor your cancer and check for any changes. You won’t usually have any treatment unless you get symptoms.

You’ll normally have a prostate specific antigen (PSA) blood test at your GP surgery or hospital clinic around once a year. Each hospital may do things slightly differently, so ask your doctor or nurse for more information on how often you will have a PSA test.

You may have other tests, depending on your symptoms. For example, you may have a digital rectal examination (DRE) and other blood tests. You probably won’t need to have regular scans or prostate biopsies. 

If any changes are picked up by these tests or you have any new or different symptoms, you may be given an appointment with the doctor or nurse. This could be at your GP surgery or at the hospital.

What symptoms should I look out for?

You should let your GP or doctor or nurse at the hospital know if you notice any symptoms or changes to your health. Things to look out for include:

• any changes to your urinary habits, for example needing to urinate (wee) more often, especially at night
• problems urinating such as a weak or slow flow
• blood in your urine
• new aches and pains in your back or bones
• fatigue (extreme tiredness)
• unexplained weight loss
• new swelling in your legs.

Ask your doctor or nurse if there are any other symptoms or changes to your health that you should look out for, as well as who to contact about them.

What happens if I get symptoms?

If you start to notice any of these symptoms you might need more tests to see if your cancer has spread, and you may be offered treatment.

A common treatment to control the prostate cancer and help improve symptoms is hormone therapy. This usually shrinks the cancer cells, wherever they are in the body, and slows down the growth of the cancer. However, hormone therapy can also cause side effects.

There are also treatments available to manage specific symptoms, such as pain relief drugs and radiotherapy. For example, radiotherapy may be used to improve pain if your prostate cancer has spread to the bones or other areas in the body (advanced prostate cancer).

Making a decision

Deciding whether to go on watchful waiting or have treatment can be difficult. Discuss all your treatment options with your doctor or nurse – they’ll be able to help you think about the advantages and disadvantages. Give yourself time to think about what is right for you. Make sure you’ve got all the information you need, and have the details of someone to contact if you have any questions.

You can ask for a second opinion about your treatment from a different doctor or care team, if you would like one. Most doctors or healthcare teams will be happy for you to have one and will refer you to a different doctor.

What if I change my mind?

If you’re on watchful waiting but decide you want treatment, speak to your doctor or nurse. They can discuss any treatments that may be suitable for you.

Dealing with prostate cancer

Being diagnosed and living with prostate cancer can change how you think and feel about life. If you or your loved one is dealing with prostate cancer, it's normal to feel scared, stressed or even angry. There are things you can do to help yourself and people who can help. Also, our Wellbeing Hub has information to help support you in looking after your emotional, mental, and physical wellbeing.

If you are close to someone with prostate cancer, find out more about how you can support someone with prostate cancer and where to get more information.

Questions to ask your doctor or nurse

• Why is watchful waiting suitable for me?
• Why can’t my prostate cancer be cured?
• Are any treatments suitable for me?
• What tests will I need, and how often?
• What signs and symptoms should I look out for?
• If I notice any new symptoms, who should I contact?
• When might I start to have treatment, and what would this involve?

References and reviewers

Updated: November 2024 | To be reviewed: November 2027