Introduction

Prostate cancer affects many men. In fact, doctors will diagnose over 268,000 new cases in the United States in 2024. But here’s the good news: not all prostate cancers need treatment right away.

For many men, doctors suggest “watchful waiting” or “active surveillance.” This works well for those with slow-growing cancer, older age, or other health issues.

Many prostate cancers grow so slowly they may never cause problems. Some men might live their whole lives without symptoms, even without treatment.

In this guide, we’ll explore watchful waiting. You’ll learn when it makes sense, how it differs from other options, and what to expect if you choose this path.

What is Watchful Waiting?

Watchful waiting means monitoring prostate cancer without rushing into treatment. It’s based on a simple fact: many prostate cancers grow very slowly and might never harm you.

Watchful Waiting vs. Active Surveillance

People often mix up these terms, but they mean different things:

Watchful Waiting:

  • Best for older men or those with other health issues
  • Less testing and fewer doctor visits
  • Focus on handling symptoms if they appear
  • Treatment starts when symptoms show up
  • Goal: maintain quality of life and avoid treatment side effects

Active Surveillance:

  • Better for younger men with low-risk cancer
  • More testing, including regular PSA tests and biopsies
  • Treatment starts if cancer shows growth
  • Goal: delay treatment while keeping the option to cure

Dr. James Brooks from Stanford University puts it simply: “Active surveillance aims to cure, while watchful waiting accepts that something else will likely cause death before the prostate cancer does.”

When is Watchful Waiting Right for You?

Several factors help decide if watchful waiting makes sense:

Age and Life Expectancy

Men expected to live less than 10 more years often choose watchful waiting. Since prostate cancer usually grows slowly, other health issues might become more pressing.

Cancer Risk Level

Doctors group prostate cancers by risk level, based on:

  • PSA level: A blood test that checks for a protein made by the prostate
  • Gleason score: A rating (6-10) of how the cancer cells look
  • Clinical stage: How far the cancer has spread

Low-risk cancers (PSA under 10, Gleason 6, Stage T1-T2a) often work well with watchful waiting.

Overall Health

Men with other serious health problems may benefit more from watchful waiting. Treatment side effects might lower quality of life without adding years.

What You Prefer

Some men want to avoid side effects like urine leakage and erection problems. If medically suitable, watchful waiting offers a way to delay or avoid these issues.

Benefits of Watchful Waiting

Watchful waiting offers several key advantages:

Avoid Treatment Side Effects

Prostate cancer treatments can cause problems that affect daily life:

  • Surgery can cause urine leakage and erectile dysfunction
  • Radiation may cause bowel issues, urinary problems, and sexual changes
  • Hormone therapy can trigger hot flashes, low sex drive, and bone loss

By holding off on treatment, men can maintain their normal lives longer.

Lower Healthcare Costs

Research shows that watching and waiting for low-risk prostate cancer could save billions of dollars each year compared to immediate treatment.

Peace of Mind

Some men feel relief by avoiding the immediate stress of cancer treatment. That said, living with untreated cancer makes others anxious. It’s a personal choice.

The Watchful Waiting Process

First Steps

Before suggesting watchful waiting, your doctor will:

  • Do a complete physical exam
  • Run PSA blood tests
  • Perform a prostate biopsy
  • Maybe order imaging tests like MRI

Ongoing Monitoring

Watchful waiting involves:

  • Doctor visits every 6-12 months
  • PSA blood tests to track changes
  • Digital rectal exams
  • Checking for any new symptoms

When to Think About Treatment

Your doctor might suggest treatment when:

  • You develop symptoms like trouble urinating or bone pain
  • Your PSA levels rise quickly
  • Exams show the cancer is growing

At this point, treatment usually focuses on easing symptoms rather than seeking a cure.

Possible Drawbacks

Watchful waiting isn’t perfect for everyone:

Missing the Treatment Window

Waiting too long might let cancer grow beyond the point where cure is possible.

Stress and Worry

Living with untreated cancer causes anxiety for some men and their families. Studies show about 20% of men on monitoring plans report moderate to severe cancer-related worry.

Ongoing Commitment

You’ll need to keep regular check-ups and tell your doctor right away about any new symptoms.

Real Patient Stories

John’s Journey

John was 73 when doctors found his low-risk prostate cancer. With heart disease and diabetes, his doctor suggested watchful waiting.

“At first, I wanted the cancer gone,” John says. “But my doctor explained that at my age, with my other health issues, treatment might cause more problems than the cancer.”

Five years later, John’s PSA has risen slightly, but he has no symptoms. “I’m glad I chose this path. I’ve avoided surgery and still enjoy my daily life without the side effects my friend had after his surgery.”

Latest Research

PIVOT Trial

This major study compared surgery to observation in men with localized prostate cancer. After nearly 20 years of follow-up, researchers found no major difference in survival rates for men with low-risk disease. This supports watchful waiting for the right patients.

PROTECT Study

This study compared monitoring, surgery, and radiation therapy. After 10 years, while cancer grew more often in the monitoring group, overall survival was similar in all three groups. This suggests immediate treatment isn’t always needed.

Genetic Testing

New tests like Oncotype DX, Prolaris, and Decipher look at cancer cells from biopsies to predict how fast a cancer might grow. These help doctors and patients make better choices about watchful waiting.

Dr. Matthew Cooperberg from UCSF notes: “These genetic tests give us another tool to help assess risk beyond the usual clinical factors.”

Making Your Decision

Consider these factors when thinking about watchful waiting:

Talk With Your Doctor

Have an open chat with your healthcare team. Ask questions like:

  • What is my risk level?
  • How might treatment affect my daily life?
  • What would trigger a need for treatment?
  • Given my overall health, what’s best for me?

Get a Second Opinion

Talking to another specialist can give you more insight and confidence in your choice.

Find Support

These groups provide information and support:

  • Prostate Cancer Foundation: Education and support services
  • Us TOO International: Support groups for men with prostate cancer
  • Cancer Support Community: Education and emotional support

Looking Ahead

Better Risk Assessment

Ongoing research aims to better identify which men can safely choose watchful waiting through advanced imaging, genetic testing, and artificial intelligence.

Better Monitoring Methods

Less invasive monitoring tools are coming, including:

  • Advanced MRI techniques
  • Blood and urine tests for cancer markers
  • Liquid biopsies that detect cancer DNA in blood

Conclusion

Watchful waiting offers a patient-centered approach to prostate cancer. It recognizes that many prostate cancers grow slowly and prioritizes quality of life.

For carefully chosen patients—especially older men or those with other health issues—it provides an alternative to immediate treatment and its side effects.

As one patient advocate says: “Prostate cancer treatment isn’t one-size-fits-all. For some men, the best first step might be to watch and wait.”

The choice to pursue watchful waiting should come after talks with your healthcare team. Consider your cancer type, overall health, personal wishes, and quality of life goals.

Frequently Asked Questions

Is watchful waiting the same as doing nothing?

No. Watchful waiting means regular check-ups and tests. It’s an active plan, not ignoring the cancer.

Will my insurance cover watchful waiting?

Most insurance plans cover the tests and doctor visits needed for watchful waiting as part of cancer follow-up care.

How will I know if my cancer is growing?

Your doctor will check for cancer growth through PSA tests, physical exams, and by asking about symptoms. Big changes might lead to more testing.

Can I switch to treatment later?

Yes. If your cancer grows, you develop symptoms, or you change your mind, you can talk with your doctor about treatment options.

How many men on watchful waiting eventually need treatment?

Studies show about 30-50% of men on active surveillance need treatment within 10 years. For watchful waiting, the number may be lower since many men have other health concerns.

Does stress make prostate cancer grow faster?

While stress affects overall health, there’s no clear proof that it speeds up prostate cancer growth. Managing stress helps quality of life but shouldn’t worry you about your cancer.

References

Categorized in:

Procedures, Urology,