Monitoring prostate cancer
Some prostate cancers grow very slowly and may never cause any symptoms. For this reason, it may be an option to wait before starting any treatment.
On this page
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What is active surveillance (monitoring)?
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Active surveillance for early prostate cancer
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What does active surveillance involve?
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Benefits of active surveillance for early prostate cancer
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Disadvantages of active surveillance for early prostate cancer
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What is watchful waiting?
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Watchful waiting for early prostate cancer
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Watchful waiting for locally advanced prostate cancer
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What does watchful waiting involve?
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About our information
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How we can help
What is active surveillance (monitoring)?
Active surveillance means that instead of having treatment to cure the cancer straight away, your healthcare team monitors the cancer (surveillance) with tests to check if it is growing. In low risk cancers, there is a lot of evidence that it is safe to do this.
Related pages
Active surveillance for early prostate cancer
If you have early (localised) prostate cancer that is low risk (CPG1 or CPG2), your urologist may talk to you about active surveillance. They may also talk to you about active surveillance if you have intermediate risk cancer (CPG3) and decide you do not want surgery or radiotherapy straight away.
With active surveillance you avoid or delay side effects that can happen with surgery or radiotherapy, until you need treatment. Some prostate cancers may grow so slowly that you never need treatment. Or it may be a long time before you do.
If tests show the cancer is growing more quickly or you get symptoms, you will be offered 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 urologist, cancer doctor or specialist nurse (CNS) 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 use the online decision aid called Predict. You can also read more and compare treatments on the infopool.
If at any time you do not feel comfortable with having active surveillance, talk to your urologist, cancer doctor or CNS.
What does active surveillance involve?
Your healthcare team will arrange for you to have regular tests. For example, this may include:
- a multiparametric MRI scan (mpMRI scan) when you start active surveillance – if you have not already had an MRI scan
- another mpMRI scan 12 to 18 months later
- a PSA blood test every 3 to 4 months
- a digital rectal examination after 12 months.
After the first year of active surveillance, you may have tests less often. For example, you may have:
- a PSA blood test every 6 months
- a digital rectal examination every 12 months.
Your healthcare team can tell you how often you might need tests. You may have an mpMRI scan if the cancer changes. You usually only need a prostate biopsy if there are any signs the cancer may be growing.
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
Some possible benefits of active surveillance include the following:
- you avoid or delay having a radical 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 radical prostatectomy or radiotherapy.
Disadvantages of active surveillance for early prostate cancer
Some possible disadvantages of active surveillance include the following:
- You may feel very anxious about not having a treatment that could cure the cancer.
- You may find it too worrying to have to wait for test results or to 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 prostate cancer rather than cure it. With watchful waiting, you do not have regular scans or start treatment unless the cancer is changing, or you get symptoms. This means you avoid treatment and its side effects for as long as possible.
Watchful waiting for early prostate cancer
If you have early prostate cancer your doctor may talk to you about watchful waiting if:
- the prostate cancer is not causing symptoms
- you have another medical condition that makes having treatment difficult
- you are not well enough to have a radical prostatectomy or radiotherapy
- you decide you want to avoid or delay treatment and its side effects.
Watchful waiting for locally advanced prostate cancer
If you have locally advanced prostate cancer, your doctor might talk to you about watchful waiting 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?
You will meet with your doctor regularly. This is usually your GP. But sometimes it may be your urologist, cancer doctor or specialist nurse (CNS). They will ask if you have any new symptoms – for example, difficulty passing urine (peeing) or bone pain. If you do have symptoms, you may have regular blood tests to check your PSA levels.
Many people on watchful waiting will never need any treatment for their prostate cancer. If you develop any symptoms, or your PSA level rises, your GP will refer you back to the urologist at the hospital. The urologist will usually recommend hormonal therapy. This will not cure the cancer, but it can often help control it for many years.
About our information
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References
Below is a sample of the sources used in our prostate cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
C. Parker, E. Castro, K. Fizazi, et al. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2020, Volume 31, Issue 9, p1119-1134. Available from https://www.esmo.org/guidelines/esmo-clinical-practice-guideline-prostate-cancer
National Institute for Health and Care Excellence (2019) Prostate cancer: diagnosis and management (NICE guideline NG131). Last updated December 2021 to include Risk stratification for localised or locally advanced prostate cancer. Available at www.nice.org.uk/guidance/ng131
Reviewers
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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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We want our information to be as clear as possible. To do this, we try to:
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We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.
You can read more about how we produce our information here.
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