Watchful Waiting of Prostate Cancer

Prostate cancer is typically slow growing and may not need to be treated right away, if ever. Watchful waiting, also known as active surveillance, is an important alternative for men with low-risk, slow-growing cancer.

What Is Watchful Waiting?

Watchful waiting means that your cancer is carefully monitored but not treated. Active surveillance prevents overtreatment of prostate cancer.

Watchful waiting does not refer to men with elevated PSA levels who avoid diagnostic tests by watching their PSA. Men with abnormal rectal exams or elevated PSA should be seen by a urologist so that additional diagnostic tests such as imaging, lab tests or a biopsy can be performed. Read about prostate cancer screening.

If you meet the criteria for watchful waiting, your care will include:

  • PSA testing every six months
  • Physical exams every six months to a year
  • An MRI and biopsy one year after the initial cancer diagnosis. We are the only health care provider in San Diego that offers MRI-directed prostate biopsies. These biopsies can help find tumors that would otherwise go undetected.
  • Follow-up MRIs and biopsies every 2 to 4 years afterwards

At these follow-up visits, your physicians will be looking for abnormalities that may indicate your cancer is becoming more aggressive and needs to be actively treated.

For men who meet the strict criteria for watchful waiting, the 15-year prognosis is extremely good: Fewer than 1 percent of men will develop advanced prostate cancer.

Who Is a Candidate for Watchful Waiting?

Men with low-risk prostate cancer may be candidates for watchful waiting if they meet the following:

  • Low PSA (less than 10)
  • Low PSA density (less than 0.15 ng/mL/cc of prostate volume)
  • Low volume of cancer on prostate biopsy
  • Gleason score less than or equal to 6
  • Stage T1C or T2A

About 15 to 20 percent of newly diagnosed men meet the strict criteria for watchful waiting. When older, less healthy men are included, at least a third of newly diagnosed men may be appropriate candidates. Read about Prostate Cancer: Grade and Stage in our Health Library.

Delay of Prostate Cancer Treatment

About 30 to 40 percent of men who choose active surveillance will require prostate cancer surgery or radiation treatment eventually. If you are a younger man diagnosed with low-risk prostate cancer, research has shown that if you start in an active surveillance program after diagnosis and then end up needing treatment, the outcome rates after treatment are the same as for those who are treated at the time of diagnosis.