Watchful waiting is an alternative to prostate cancer treatment for people who have cancer that isn't causing significant symptoms or problems.

Prostate cancer treatments may cause side effects and other issues that could impact your day-to-day life more than the cancer itself does. With watchful waiting, your medical team monitor your cancer for changes instead of treating it. You will only have treatment if you develop symptoms or problems.

People tend to choose watchful waiting as a prostate cancer treatment option for the following reasons:

• Prostate cancer can grow slowly – therefore treating it isn’t urgent.
• Their prostate cancer may not cause symptoms or problems for a long time – so people choose to avoid unnecessary treatment until their cancer starts to cause problems.
• They have another condition – one that may cause problems before the prostate cancer does.
• Many treatments cause side effects – for some people, the side effects can be worse than not treating the prostate cancer.

Watchful waiting may be suggested if you are older and the cancer is unlikely to cause a problem during your remaining lifetime. In general, watchful waiting may be suitable for you if:

• cancer treatments may not help extend your life
• your prostate cancer isn’t causing symptoms or issues
• your medical team have told you that your cancer probably won’t cause symptoms or issues in the immediate future.

Many people who opt for watchful waiting never need treatment. If you decide to go on watchful waiting and things change, you can still have treatment to control your symptoms, but it will not be curative.

Before deciding whether watchful waiting may be suitable for you, discuss your situation with your medical team.

Watchful waiting is not the same as active surveillance. However, both approaches are similar, as they are designed to help you avoid having treatments you don’t necessarily need.

The key difference is that active surveillance is for low-grade prostate cancer; if the disease progresses, your medical team could then consider active treatment to cure it. Watchful waiting means observing the prostate cancer; you only consider treatment when it becomes symptomatic, aiming to slow the disease.

Watchful waiting is beneficial for people who:

• need symptom control rather than a cure – there are different reasons why this may be the case for you, such as older age and other complex illnesses or conditions
• have other health problems – and therefore may not benefit from having active treatment
• may not ever have cancer problems – due to the type of prostate cancer.

Active surveillance, on the other hand, is most suitable for people who:

• have slow-growing cancer – and the cancer hasn’t spread and is unlikely to spread
• would benefit from treatment if they ever needed it – your medical team can help you determine this
• can have regular hospital tests – such as magnetic resonance imaging (MRI) scans and prostate biopsies.

Your medical team can discuss the pros and cons of both approaches and help you determine which might be suitable for your circumstances.