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)?
Related pages
Active surveillance for early prostate cancer
If you have early prostate cancer that is low-risk or sometimes intermediate-risk, your doctor may talk to you about active surveillance.
Some prostate cancers may grow so slowly that you never need treatment. Or it may be a long time before you do.
Active surveillance means you avoid or delay side effects that can happen with surgery or pelvic radiotherapy.
If tests show the cancer is growing more quickly or you get symptoms, you have 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 doctor 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 also use the NHS online decision aid called Predict.
If at any time you do not feel comfortable with having active surveillance, talk to your doctor. They can arrange for you to start treatment to cure the cancer.
What does active surveillance involve?
Your doctor will arrange for you to have regular tests, for example:
- a multiparametric MRI scan when you start active surveillance (if you have not already had an MRI scan)
- another MRI scan 12 to 18 months later
- a PSA blood test every 3 to 4 months
- a rectal examination after 12 months.
You may have an MRI scan if the cancer changes. You usually only need a prostate biopsy if there are any signs the cancer may be growing.
After the first year of active surveillance you may have tests less often, for example:
- a PSA blood test every 6 months.
- a rectal examination every 12 months.
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
The benefits of active surveillance for early prostate cancer are:
- you avoid or delay having a 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 prostatectomy or radiotherapy.
Disadvantages of active surveillance for early prostate cancer
The disadvantages of active surveillance for prostate cancer are:
- you may feel very anxious about not having a treatment that could cure the cancer
- you may find it too worrying to wait for test results or 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?
Watchful waiting for early prostate cancer
If you have early prostate cancer your doctor may talk to you about watchful waiting (watch and wait) if you are not well enough to have a prostatectomy or radiotherapy.
Or you may choose this approach if you decide you do not want radiotherapy or surgery.
Watchful waiting means you will not have as many tests as with active surveillance.
Watchful waiting for locally advanced prostate cancer
If you have locally advanced prostate cancer, your doctor might talk to you about watchful waiting (watch and wait) 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?
Instead of having treatment, you 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.
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 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 www.esmo.org/guidelines/genitourinary-cancers/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.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.
The language we use
We want everyone affected by cancer to feel our information is written for them.
We want our information to be as clear as possible. To do this, we try to:
- use plain English
- explain medical words
- use short sentences
- use illustrations to explain text
- structure the information clearly
- make sure important points are clear.
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.
Date reviewed
Our cancer information meets the PIF TICK quality mark.
This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.