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 any 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 usually 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 usually involves more regular hospital tests than watchful waiting, such as magnetic resonance imaging (MRI) scans and prostate biopsies.

Other names 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 help you to live longer
• your prostate cancer isn’t likely to cause any problems during your lifetime or shorten your life.

Make sure you've discussed other treatment options with your doctor.

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 have.

Talk to your doctor or nurse about all your options. They can explain your test results and discuss your treatment options with you. You can also speak to 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 may be an advantage for one person might not be for 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 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.
• Some men may worry about their cancer growing and about getting symptoms.
• Partners and family members 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 will have tests to monitor your cancer. You won’t 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 every 6 to 12 months. This will help to check for any changes to your prostate cancer.

You might also have digital rectal examinations (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 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.

The most common treatment to control the cancer and help improve symptoms is hormone therapy. This 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. For example, if your prostate cancer has spread to the bones (advanced prostate cancer) it can cause bone pain. Treatments to manage bone pain include pain-relieving drugs and radiotherapy.

Making a decision

It’s up to you whether to go on watchful waiting or have treatment – but it can be a difficult decision to make. Discuss all your treatment options with your doctor or nurse – they’ll be able to help you weigh up the pros and cons. 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, if you want one. You don’t have a legal right to a second opinion, but most doctors 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.

Questions to ask your doctor or nurse

• Why is watchful waiting suitable for me?
• 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: December 2019 | To be reviewed: December 2020