Prostate Cancer: When Treatment Can Wait

Prostate cancer can grow very slowly. In some men, it can grow so slowly they may never need treatment. But doctors still want to keep an eye on the cancer so they can take action if it gets worse. This approach is known as active surveillance or watchful waiting.

Your doctor may have suggested these options instead of other treatment for a few reasons:

  • Your age
  • Other health conditions you have, such as heart disease, diabetes, stroke, or other cancer
  • Risks and side effects of treatment
  • Your tumor is small
  • You don’t have symptoms

Some doctors say “active surveillance” or “watchful waiting” to mean the same thing -- tracking the cancer and how it may or may not grow. Others think these terms are slightly different. If your doctor talks with you about either term, ask them exactly what they mean by it.

Active Surveillance

With this method, your doctor will use regular tests to check your disease. You’ll have a doctor’s appointment usually about every 3 to 6 months for:

Digital rectal examination. Your doctor will place a gloved finger into your rectum to feel the surface of your prostate for bumps that could be tumors.

Prostate-specific antigen (PSA) test. Doctors check a sample of your blood for the amount of PSA, a protein your prostate makes. Men who have prostate cancer usually have higher levels of it.

Scans. Your doctor might use different imaging tests to take a picture of your prostate. Magnetic resonance imaging (MRI) uses powerful magnets and radio frequency (RF) to make images. Ultrasound uses sound waves to do the same thing. The pictures will help tell your doctor if the disease has spread outside your prostate.

Your doctor may also take small pieces of tissue from your prostate in a procedure called a biopsy and study it under a microscope to look for changes. You’ll probably get one once a year.

As long as these tests don’t show any changes, your doctor will continue to closely watch the cancer without recommending that you start treatment.


If test results show that your tumor is growing or you’re having symptoms, your doctor will discuss options for treatments that will try to cure the cancer.

The risk for active surveillance is that it can give the cancer a chance to grow or spread. That can limit your options for treatment later. The benefit is that if the cancer is growing, it will likely be caught and treated. For many men this never happens, so they don't have to suffer any potential consequences of unnecessary treatment.

The younger you are, the less likely it is your doctor will recommend this approach. Even though the tumor is growing slowly, it can still give you problems 20 or 30 years from now.

Watchful Waiting

Watchful waiting is more hands-off. There will be fewer tests. Instead, you and your doctor make decisions based on your symptoms.

Your doctor may suggest this method if:

  • You have other health conditions that could make treatment too hard to handle.
  • The prostate cancer probably won’t cause you any problems in your lifetime.

If you have symptoms, you and your doctor can decide at that time whether you need treatment.

Risks of Treatment

The decision to go with active surveillance or watchful waiting is a personal one. But your doctor will discuss these options with you, because treatments such as surgery, radiation, or chemotherapy can be rough on your body. In some cases, the risks and side effects of these treatments are greater than the benefits of killing the cancer. Impotence and urinary incontinence are two such side effects. 


Scientists also are still debating whether options such as surgery or radiation always help men with slow-growing prostate cancer actually live longer. Depending on how old you are and if you have other health conditions, you might decide that treatment isn’t worth the risks.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on September 04, 2020



American Society of Clinical Oncology: “Prostate-Specific Antigen (PSA) Testing for Prostate Cancer Screening."

American Cancer Society: “Expectant management, watchful waiting, and active surveillance for prostate cancer.”

Prostate Cancer Foundation: “Living With Prostate Cancer: Active Surveillance”

American Urological Association: “Guideline for the Management of Clinical Localized Prostate Cancer (2007)”

American College of Radiology and Radiological Society of North America: “Magnetic Resonance Imaging (MRI – Prostate”

New York University Langone Medical Center: “Active Surveillance or Watchful Waiting.”

Prostate Cancer UK. “Choosing a Treatment: Active Surveillance.”

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