Some prostate cancers grow very slowly and may never cause any symptoms. For this reason, some men decide with their specialists to wait before starting any treatment.

Active surveillance for early prostate cancer

Active surveillance means you will have regular tests to check whether the prostate cancer is growing. Your doctor may monitor you and offer some tests, such as:

  • an MRI scan when you start active surveillance, if you have not had one before
  • a rectal examination every 6 to 12 months
  • blood tests every 3 to 6 months to check your PSA levels
  • a prostate biopsy or another MRI scan after 1 year of active surveillance.

If the cancer is not getting any bigger or growing more quickly, it is safe to continue with active surveillance. Some men on active surveillance may never need treatment for prostate cancer.

If any of the tests show the cancer is starting to grow more quickly, your doctors will recommend surgery or radiotherapy to try to cure the cancer.

Watchful waiting for early and locally advanced prostate cancer

If you have early prostate cancer, you will usually be offered watchful waiting if you are not well enough to have radiotherapy or surgery. For example, this might be because you have another health condition.

You may also be offered watchful waiting if you have chosen not to have radiotherapy or surgery.

If you have locally advanced prostate cancer, you will only be offered watchful waiting if you are not well enough to have, or chosen not to have, radiotherapy or surgery.

You will not have as many tests as with active surveillance (see above). Instead, you will 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. You may also have rectal examinations.

You will not need a scan or prostate biopsy unless the cancer starts to grow.

If there is no sign that the cancer is getting bigger or growing more quickly, it is safe to continue with watchful waiting.

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 help control it. In some men, hormonal therapy can control prostate cancer for many years.

Advantages of monitoring prostate cancer

  • You can avoid treatment such as surgery or radiotherapy.
  • You can avoid or delay the side effects of treatment.

Disadvantages of monitoring prostate cancer

  • You may find it difficult to cope with knowing the cancer is not being treated straight away.
  • Very rarely, a cancer that has progressed during active surveillance may not be curable. But if this happens, the cancer can be controlled with long-term hormonal therapy.

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