Active Surveillance (Prostate)

The Basics

Watchful waiting and active surveillance are treatments used for older men who do not have signs or symptoms or any other medical conditions. These are also used in men for prostate cancer.

Active surveillance involves closely following a patient’s condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are asked to go through specific exams and tests, including a digital rectal test, PSA test, transrectal ultrasound, and transrectal needle biopsy, to check if the cancer is growing. When cancer begins to grow, treatment is given to cure cancer.

Observation or watchful waiting is closely monitoring a patient’s condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve quality of life.

The difference between watchful waiting and active surveillance

Watchful waiting is often confused with active surveillance, which is another way of monitoring prostate cancer. Both aim to avoid unnecessary treatment, but the reasons for having them are different. Check with your doctor which one you’re being offered.

Active surveillance

  • If you need treatment at any point, it will usually aim to cure cancer.
  • It is only suitable for men with slow-growing cancer that hasn’t spread outside the prostate. They would benefit from treatment such as surgery or radiotherapy if they needed it.
  • It usually involves more regular hospital tests than watchful waiting, such as magnetic resonance imaging (MRI) scans and prostate biopsies.

Watchful waiting

  • If you have treatment at any point, it will usually aim to control cancer and manage any symptoms rather than cure it.
  • It’s generally suitable for men with other health problems who may not benefit from treatment such as surgery or radiotherapy, or whose cancer may never cause problems during their lifetime.
  • It usually involves fewer tests than active surveillance. These check-ups usually occur at the urologist’s office rather than at the hospital.

Other names you might hear

Some people use names such as ‘active monitoring’, ‘deferred therapy’, ‘watch and wait’, and ‘wait and see’ to describe both watchful waiting and active surveillance. These can mean different things to different people, so ask your doctor or nurse to explain exactly what they mean.

Who can go on watchful waiting?

Watchful waiting may be suitable for you if your prostate cancer isn’t causing any symptoms or problems, and:

  • treatments may not help you to live longer
  • your prostate cancer isn’t likely to cause any problems during your lifetime or shorten your life.

Make sure you’ve discussed other treatment options with your doctor.

Can I have treatment instead of watchful waiting?

Treatment options will be available if you don’t want to go on watchful waiting. These will depend on whether your cancer has spread, how quickly it might grow, and any other health problems you have.

Talk to your doctor or nurse about all your options. They can explain your test results and discuss your treatment options with you.

What are the advantages and disadvantages of watchful waiting?


  • You’ll avoid the side effects of treatment while you’re on watchful waiting.
  • You won’t need to have regular MRI scans or prostate biopsies.
  • If you get symptoms, treatments can help manage them. But many men never need any treatment.


  • There is a chance that cancer may change and grow. If this happens, you can start hormone therapy to shrink cancer and treat the symptoms.
  • Some men may worry about their cancer growing and about getting symptoms.
  • Partners and family members may struggle to understand why they aren’t receiving treatment.

You can make an informed decision by getting relevant information from free Ankr platform or Ankr app

What symptoms should I look out for?

  • any changes to your urinary habits
  • Urinating more often than normal at night
  • problems urinating, such as a weak or slow flow
  • blood in urine
  • new aches and pains in your back or bones
  • fatigue (extreme tiredness)
  • unexplained weight loss
  • new swelling in your legs

Ask your doctor or nurse if there are any other symptoms or changes to your health that you should look out for and who to contact about them. You can help them by tracking your side effects in Ankr.

What happens if I get symptoms?

If you start to notice any of these symptoms, you might need more tests to see if your cancer has spread, and need treatment. Hormone therapy is the most common treatment to control cancer and help improve symptoms. This shrinks the cancer cells, wherever they are in the body, and slows cancer growth. However, hormone therapy can also cause side effects. The treatment includes therapies for completely removing or at least reducing the symptoms.

Speak to your doctor or nurse if you’re on watchful waiting but want treatment. They can discuss any treatments that may be suitable for you.

Questions to ask your doctor or nurse

  • Why is watchful waiting suitable for me?
  • Are any treatments suitable for me?
  • What tests will I need, and how often?
  • What signs and symptoms should I look out for?
  • If I notice any new symptoms, who should I contact?
  • When might I start to have treatment, and what would this involve?

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DISCLAIMER: No part of this content constitutes medical advice, opinion, or should be used for medical decision making without consultation with a licenced medical practitioner and under a patient-provider relationship. All information on the website is provided without any claims of accuracy. For full terms and conditions, visit this link. Content curated by the Ankr team.

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