Observation or Active Surveillance for Prostate Cancer

Because prostate cancer often grows very slowly, some men (especially those who are older or have other serious health problems) who have it might never need treatment. Instead, their doctors may recommend observation (sometimes called watchful waiting) or active surveillance.

The terms active surveillance and observation mean something slightly different:

  • Active surveillance is often used to mean monitoring the cancer closely. Usually this includes a doctor visit with a prostate-specific antigen (PSA) blood test about every 6 months and a digital rectal exam (DRE) at least once a year. Prostate biopsies and imaging tests may be done every 1 to 3 years as well. If your test results change, your doctor would then talk to you about treatment options to try and cure the cancer.
  • Observation (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. This treatment is most often meant to control symptoms from the cancer, but not to cure it.  

No matter which term your doctor uses, it’s very important for you to understand exactly what he or she means when they refer to it.

When are these options used?

One of these approaches might be recommended if your cancer:

  • Isn’t causing any symptoms
  • Is expected to grow slowly (based on Gleason score)
  • Is small
  • Is just in the prostate
  • Is associated with low PSA level (<10ng/ml)

They are not likely to be good options if you have a fast-growing cancer (for example, a high Gleason score) or if the cancer is likely to have spread outside the prostate (based on PSA levels). Men who are young and healthy are less likely to be offered observation, out of concern that the cancer might become a problem over the next 20 or 30 years.

Observation and active surveillance are reasonable options for some men with slow-growing cancers because it is not known if treating the cancer with surgery or radiation will actually help them live longer. In active surveillance, only men whose cancer is growing (and therefore have a more serious form of cancer) are treated. For some men. these treatments have risks and side effects that may outweigh their benefits. Other men are not comfortable with observation or active surveillance because the cancer might grow and spread, limiting treatment options and the possibility of treating the cancer successfully. Some men accept the possible side effects of treatments to try to remove or destroy the cancer.

Observation or active surveillance vs. treatment

A few large studies have compared observation (watchful waiting) (where men were treated only if they developed symptoms from their cancer) and surgery for early-stage prostate cancer, but the evidence from these studies has been mixed. Some have found that men who have surgery might live longer, while others have not found a difference in survival.

So far, a few studies have compared active surveillance to treatments such as surgery or radiation therapy. Men who undergo surgery or radiation do not appear to live longer than those that undergo active surveillance, but their cancer might stay away longer and spread less.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Chen RC, Rumble RB, Loblaw DA, Finelli A, Ehdaie B, Cooperberg MR, et al. Active Surveillance for the Management of Localized Prostate Cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement. J Clin Oncol. 2016 Jun 20;34(18):2182-90. doi: 10.1200/JCO.2015.65.7759. Epub 2016 Feb 16.

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National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Prostate Cancer. Version 1.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf on March 19, 2019.

Nelson WG, Antonarakis ES, Carter HB, DeMarzo AM, DeWeese TL, et al. Chapter 81: Prostate Cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.

Zelefsky MJ, Morris MJ, and Eastham JA. Chapter 70: Cancer of the Prostate. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.

Last Medical Review: August 1, 2019 Last Revised: August 1, 2019

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