What is active surveillance (monitoring)?

Instead of having treatment to cure the cancer straight away, your doctor will monitor the cancer (surveillance) with tests to see if it is growing. In low-risk cancers there is a lot of evidence that it is safe to do this.

Active surveillance for early prostate cancer

If you have early prostate cancer that is low-risk or sometimes intermediate-risk, your doctor may talk to you about active surveillance.

Some prostate cancers may grow so slowly that you never need treatment. Or it may be a long time before you do.

Active surveillance means you avoid or delay side effects that can happen with surgery or pelvic radiotherapy.

If tests show the cancer is growing more quickly or you get symptoms, you have treatment to cure the cancer straight away. The risk of the cancer growing without being found with tests is very low.

You will need to talk to your doctor about whether active surveillance is right for you. They will explain the benefits and disadvantages.

You can think about how certain side effects may affect your life, as well as how you feel about how the cancer is managed. You can then decide what is the best option for you. You can also use the NHS online decision aid called Predict.

If at any time you do not feel comfortable with having active surveillance, talk to your doctor. They can arrange for you to start treatment to cure the cancer.

What does active surveillance involve?

Your doctor will arrange for you to have regular tests, for example:

You may have an MRI scan if the cancer changes. You usually only need a prostate biopsy if there are any signs the cancer may be growing.

After the first year of active surveillance you may have tests less often, for example:

  • a PSA blood test every 6 months.
  • a rectal examination every 12 months.

If the cancer is not getting any bigger or growing more quickly, it is safe to continue with active surveillance.

Benefits of active surveillance for early prostate cancer

The benefits of active surveillance for early prostate cancer are:

  • you avoid or delay having a prostatectomy or radiotherapy
  • you can avoid or delay the side effects of treatment
  • your chance of living for another 10 years with active surveillance is the same as with prostatectomy or radiotherapy.

Disadvantages of active surveillance for early prostate cancer

The disadvantages of active surveillance for prostate cancer are:

  • you may feel very anxious about not having a treatment that could cure the cancer
  • you may find it too worrying to wait for test results or look out for symptoms
  • there is a small risk the cancer may grow outside the prostate or spread to other parts of the body during active surveillance.

What is watchful waiting?

The aim of watchful waiting is to control the symptoms of cancer rather than cure it. You can have treatment if there are signs the cancer is growing, or if it is starting to cause symptoms.

Watchful waiting for early prostate cancer

If you have early prostate cancer your doctor may talk to you about watchful waiting (watch and wait) if you are not well enough to have a prostatectomy or radiotherapy.

Or you may choose this approach if you decide you do not want radiotherapy or surgery.

Watchful waiting means you will not have as many tests as with active surveillance.

Watchful waiting for locally advanced prostate cancer

If you have locally advanced prostate cancer, your doctor might talk to you about watchful waiting (watch and wait) if:

  • you are older and do not have symptoms
  • you have another medical condition that makes having treatment difficult
  • you decide you want to avoid or delay treatment and its side effects.

What does watchful waiting involve?

Instead of having treatment, you see your doctor regularly (usually your GP). They will ask if you have any new symptoms, such as difficulty passing urine (peeing) or bone pain. If you do have symptoms, you may have regular blood tests to check your PSA levels.

If you have any symptoms, or your PSA level rises, your GP will refer you back to the specialist at the hospital. They will usually recommend hormonal therapy. This will not cure the cancer, but it can often help control it for many years.

About our information

Reviewers

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editors, Dr Jim Barber, Consultant Clinical Oncologist and Dr Ursula McGovern, Consultant Medical Oncologist.

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