Because prostate cancer often grows very slowly, some men (especially those who are older or have other serious health problems) may never need treatment for their prostate cancer. Instead, their doctors may recommend an approach known as expectant management, or "watchful waiting." This approach involves closely monitoring the cancer without active treatment such as surgery or radiation therapy. It may be recommended if your cancer is not causing any symptoms, is expected to grow very slowly, and is small and contained within one area of the prostate.

Watchful waiting is less likely to be a good option if you are young, healthy, and/or have a fast-growing cancer (for example, a high Gleason score).

At this time, watchful waiting is a reasonable option for some men with slow-growing cancers because it is not known whether treating the cancer with surgery or radiation will actually help them live longer. These treatments have definite risks and side effects that may outweigh the possible benefits for some men. Some men are not comfortable with this approach, and are willing to accept the possible side effects of active treatments in order to try to remove or destroy the cancer.

Watchful waiting does not mean that you will not receive medical care or follow-up. Rather, your cancer will be carefully monitored. Usually this approach includes a doctor visit with a PSA blood test and digital rectal examination (DRE) about every 3 to 6 months. Transrectal ultrasound-guided prostate biopsies may be done every year as well. If you develop bothersome symptoms or your cancer begins to grow more quickly, you can consider active treatment. A possible downside of this approach is that there's a chance it could allow the cancer to become more advanced, which might limit treatment options.

Hopefully we will have a better idea of the pros and cons of watchful waiting versus active treatment in the near future. A large study sponsored by the National Cancer Institute and the Veterans Affairs Cooperative Studies Program is now looking into how active treatment affects survival and quality of life of prostate cancer patients of different ages. The PIVOT (short for Prostatic Intervention Versus Observation Trial) is still in progress.