Expectant management (watchful waiting) and active surveillance for prostate cancer

Because prostate cancer often grows very slowly, some men (especially those who are older or who have other major health problems) may never need treatment for their cancer. Instead, their doctor may suggest approaches called watchful waiting (also called expectant management) or active surveillance.

Some doctors use these terms to mean the same thing. For other doctors the terms mean something slightly different:

Active surveillance is often used to mean watching the cancer closely with PSA blood tests, digital rectal exams (DREs), and ultrasounds at regular intervals to see if the cancer is growing. Prostate biopsies may be done as well to see if the cancer is starting to grow faster. If there is a change in your test results, your doctor would then talk to you about treatment options.

Watchful waiting is sometimes used to describe a less intensive type of follow-up that may mean fewer tests and relying more on changes in a man's symptoms to decide if treatment is needed.

Not all doctors agree with these definitions or use them exactly this way. In fact, some doctors prefer to no longer use the term watchful waiting because it implies that nothing is being done, when in fact a man is still being closely followed. No matter which term your doctor may use, it is very important to understand exactly what he or she means when they refer to it.

Right now, not all experts agree how often testing should occur for active surveillance. There is also debate about when is the best time to start treatment if things change. Still, some early studies have shown that men who choose active surveillance and later go on to be treated tend to do just as well as those who decide to start treatment right away.

Either of these methods may be a good choice if the cancer is not causing any symptoms, is likely to grow slowly, and is small and contained in the prostate. It is less often a choice if you are young, healthy, and have a cancer that is growing fast.

Some men choose this approach because, in their view, the side effects of treatment outweigh the benefits. Others are willing to accept the possible side effects of active treatment in order to try to remove or destroy the cancer.