Watchful waiting is a way of monitoring prostate cancer without starting treatment straight away. It is generally used when the cancer is not causing symptoms and when treatment intended to cure the cancer is unlikely to provide enough benefit to outweigh its possible side effects or burden.
The aim is to avoid unnecessary treatment while continuing to monitor your health. If the cancer begins to cause symptoms or other important changes occur, treatment can be offered to control the cancer and relieve symptoms.
Read NHS information about monitoring prostate cancer.
Who may be offered watchful waiting?
Watchful waiting may be suitable when prostate cancer is unlikely to cause significant problems during a person’s lifetime, or when other health conditions mean that treatments such as surgery or radiotherapy would not be appropriate.
Your specialist team will consider the characteristics of your cancer, your general health, life expectancy, possible treatment side effects and your own preferences when discussing whether watchful waiting is appropriate.
What does watchful waiting involve?
Watchful waiting usually involves fewer tests than active surveillance. Follow-up varies according to your circumstances and local arrangements, but may include PSA blood tests, appointments with your GP or specialist team, and discussion of any new symptoms.
NICE recommends that people with localised prostate cancer on watchful waiting who are followed up in primary care should have their PSA measured at least once a year.
Read NICE recommendations on prostate cancer follow-up.
When might treatment be started?
If the cancer begins to cause symptoms or there is evidence of significant progression, your healthcare team will review the situation and discuss treatment options with you.
Treatment at this stage is usually intended to control the cancer and manage symptoms rather than cure it. Hormone therapy is one treatment that may be considered, depending on your circumstances.
Contact your healthcare team if you develop new or worsening symptoms rather than waiting for your next planned appointment.
Watchful waiting is not the same as active surveillance
Watchful waiting generally involves less intensive monitoring. If treatment becomes necessary, its main purpose is usually to control the cancer and symptoms.
Active surveillance is a structured programme of PSA tests and other investigations for people whose cancer may still be treated with the aim of cure if it shows signs of progression.
See our Active Surveillance page for more information.
Benefits and possible disadvantages
A major benefit of watchful waiting is avoiding or delaying treatment and its possible side effects when treatment may not be necessary.
Possible disadvantages include anxiety about living with prostate cancer and the possibility that symptoms may develop over time. Your healthcare team can explain what changes to look out for and who to contact if you become concerned.
Questions to ask your specialist
- Why are you recommending watchful waiting for me?
- How often will I need PSA tests or appointments?
- What symptoms or changes should I report?
- Who should I contact if I become worried between appointments?
- What treatment could I have if the cancer begins to cause problems?
- How is watchful waiting different from active surveillance in my situation?
This information provides a general introduction to watchful waiting for prostate cancer and does not replace advice from your GP, urologist, oncologist or specialist cancer team.