Treating Prostate Cancer With “Watchful Waiting”

Watchful waiting and active surveillance are two terms that are often bandied about when discussing prostate cancer treatment. But are watchful waiting and active surveillance the same thing or do they refer to different ways to approach prostate cancer?

Despite a tendency to dismiss these two treatment approaches as being the same, those with a discerning eye and ear for the English language will likely insist they are not the same—and they would be correct. Knowing the differences between watchful waiting and active surveillance and, more important, knowing which one to follow can be critical.

What is watchful waiting?

Watchful waiting implies nonactivity or passivity: you watch a situation and wait yet do not initiate any action. It’s like watching a parade: you see it passing by, yet you don’t go out and join it.

Among men with prostate cancer, watchful waiting is generally reserved for those whose cancer is likely not going to be their cause of death nor is it a situation that will cause them a significant reduction in their quality of life. Factors that typically are taken into consideration are a man’s age, the stage of prostate cancer, the history of the disease up to that point, the presence of any other health issues, and a man’s personal feelings about treatment of prostate cancer.

Men in the watchful waiting category tend to be older (about 70 years or older) with a Gleason score of 6 and a PSA less than 20 ng/mL, although this is not always the case. Watchful waiting also may be the action of choice among younger men who have been diagnosed with a low-risk prostate cancer, since treatment has a chance of causing significant side effects that can affect quality of life. The longer they can delay any potential complications and side effects, the better. For many younger men, watchful waiting means many years of being free of active treatment for prostate cancer and its associated problems.

What is active surveillance?

Active surveillance implies some positive action but one that is tempered by a watchfulness as well. In practice, active surveillance involves putting off or delaying the first line of treatment (e.g., radiation, prostatectomy, chemotherapy, hormone therapy) until it becomes necessary, if it ever does.  The “active” part of this approach involves monitoring the patient’s health with regular PSA testing (prostate-specific antigen) and possibly prostate biopsy and magnetic resonance imaging (MRI). Importantly, diet and lifestyle modifications are also strongly promoted as part of a program for maintaining prostate health and reducing the risk of progression.

If any of the active surveillance reveals signs that the prostate cancer is progressing, then a man and his physician can discuss the best treatment approach. Some men maintain active surveillance for years before they need to take any more aggressive action.

In a study from the University of California, San Francisco, presented at the American Urological Association’s annual meeting in May 2012, researchers reported on data from a retrospective review of 775 men who tried active surveillance for at least six months between 1990 and 2011.

At the time of the report, 652 of the men had chosen active treatment, and the main reasons for doing so were progression of the disease seen on prostate biopsy (59%) and other clinical signs or personal preference (38%). Overall survival of the treated men was 97% with a five-year disease-specific survival of 100%.

If you have been diagnosed with prostate cancer, watchful waiting and active surveillance are two treatment options among many that should be offered to you. Be sure to ask your physician questions about the pros and cons of watchful waiting and active surveillance as well as all the other options before making any treatment decisions.

Read more in our Prostate Cancer Health Center.


Glass AS et al. Active survillance: an update from a large contemporary cohort. American Urological Association meeting May 2012. Abstract 376

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