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Watchful Waiting - What to Know About Watchful Waiting

When Is Watchful Waiting a Good Alternative to Active Treatment?


Updated June 11, 2009

Watchful waiting, sometimes known as active surveillance, is an alternative to active treatment for prostate cancer that can be a good option for some men.

If watchful waiting is chosen, then you would not undergo any active treatment initially. Instead, your prostate cancer would be closely monitored using regular PSA tests, digital rectal examinations, and possibly other tests to look for any changes that may signal that your prostate cancer is growing more quickly. Typically, PSA tests and digital rectal examinations are done every 3 to 6 months to monitor your cancer.

Who Is a Potential Candidate for Watchful Waiting?

  • Men who may be good candidates for watchful waiting are those whose prostate cancer is likely to grow and spread slowly and not result in any significant complications.

  • Men who are elderly or who have other significant medical problems are more likely to die from non-prostate cancer causes and, therefore, are unlikely to benefit from active treatment of their prostate cancer.

  • Men who have a strong reason for wanting to avoid the potential side effects of active treatment may also be good candidates for watchful waiting.

How Do You Know if Your Prostate Cancer Will Grow Slowly or Quickly?

Determining whether any given man's prostate cancer will grow slowly or quickly is difficult. However, some factors can be used to make as good a guess as possible.

Men who have a prostate cancer of small size, who have a low PSA, and who have a low Gleason score are more likely to have slow-growing prostate cancer than men who have a prostate cancer of large size (or that has spread outside the prostate), who have a high PSA, or who have a high Gleason score.

Unfortunately, not all prostate cancers fall into these neat and tidy categories. Sometimes small, low PSA, low Gleason score prostate cancers grow and spread quickly. Also, it is not always possible to know the full extent of prostate cancer. This means that cancer that seems to be small and confined to the prostate may actually be larger and more disseminated than it appears.

The Benefits of Watchful Waiting

The primary benefit to watchful waiting is the avoidance of all possible side effects from active treatment. Treatment complications such as urinary incontinence, erectile dysfunction, pain, and others are definite possibilities following active treatment.

The Risks of Watchful Waiting

The primary risk of watchful waiting is that your prostate cancer may grow and spread beyond the prostate without active treatment. This is obviously a big risk, especially for men who are younger and relatively healthy.

Sometimes even small, seemingly slow-growing prostate cancers can spread beyond the prostate without active treatment.

Should You Choose Watchful Waiting?

Only through careful consultation with your doctor can you make a good decision about whether to pursue active treatment or watchful waiting. Most men today choose active treatment, but this may or may not be the right choice for you.


Klotz LH. Active surveillance for good risk prostate cancer: rationale, method, and results. Can J Urol. 2005 Jun;12 Suppl 2:21-4.

Mols F, van de Poll-Franse LV, Vingerhoets AJ, et al. Long-term quality of life among Dutch prostate cancer survivors: results of a population-based study. Cancer. 2006 Nov 1;107(9):2186-96.

Moul JW, Saad F. Low-risk prostate cancer patient: active treatment. Can J Urol. 2005 Jun;12 Suppl 2:25-7. Review.

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