Watchful waiting – Safe for prostate cancer?

Watchful waiting is when a man doesn’t start any treatment for prostate cancer, but his doctor carefully monitors the growth of the cancer.

It is also sometimes called expectant management or active surveillance.

Different definitions

These terms may have different meanings depending upon the doctor.

It’s important to ask the doctor what his/her definition of watchful waiting is.

For example, some doctors consider active surveillance to be a more intensive form of follow-up with more tests.

An option for some


Watchful waiting is generally discussed as an option if:

  • A man is elderly and his cancer is anticipated to grow very slowly
  • He has other medical conditions that may make treatment risky
  •  It may also be discussed if it is unclear whether a treatment will help a man live longer

Significant change

Five years ago, a significant change was incorporated into the updated National Comprehensive Cancer Network (NCCN) Guidelines for Prostate Cancer.

The NCCN guidelines suggest that men with low risk prostate cancer who have a life expectancy of less than 10 years should be offered and recommended active surveillance.


In addition, a new “very low risk” category was added to the updated NCCN Guidelines for clinically insignificant prostate cancer.

The NCCN guidelines suggest that active surveillance is only offered and recommended for men in this category when their life expectancy is less than 20 years.

Your choice

This “no treatment approach” is always a personal choice. Some men may decide they are not willing to accept the risk of side effects with current treatments for prostate cancer.

The big unknown is that there is no guarantee that a man’s cancer will not become more significant over time or even become untreatable.

Watchful waiting: A big decision

This approach needs to be considered very carefully with your loved one’s entire medical team.  You both must understand the potential pros and cons.


If a man decides to take this route, he will mostly likely have:

How often testing will occur may vary depending upon the doctor, as experts don’t seem to agree on the timing.

If the results of these tests show any change — or your loved one develops troubling problems related to his cancer — his doctor will mostly likely discuss active treatment.


Return to treatments

NCCN Guidelines for Patients
.  Accessed April 18, 2014.

American Urological Association. The Management of Localized Prostate Cancer. Accessed September 1, 2008.

The American Cancer Society. Prostate Cancer. Accessed March 17, 2015.

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