What’s the Difference between Active Surveillance and Watchful Waiting when Treating Prostate Cancer?

Dr. Danil Makarov is a urologist focused on caring for men with prostate cancer

Prostate cancer often grows slow and should not be treated unless it's likely to cause a patient harm during his lifetime.

Based on the traits of a patient's prostate cancer, their overall health and medical condition, a game plan which avoids surgery and radiation may be best.

Active surveillance is where the patient and physician defer surgery or radiation right away, and instead track the cancer's status. With active surveillance, you and your doctor will follow clues from routine PSA tests, DREs (Digital Rectal Exams), biopsies and imaging (i.e. MRI) to determine if the cancer is growing or getting more aggressive. If that happens, then you and your doctor will work out the next steps for you.

Active Surveillance is best for men with small, low-risk tumors without symptoms. It is also good for men who are at a higher risk from surgery or radiation. If you want to avoid possible sexual, urinary or bowel side effects for as long as possible, this may be the treatment for you. Action is taken only if the cancer changes or grows. Active surveillance may require you to have many biopsies to track cancer growth.

Watchful waiting is a less aggressive system of monitoring prostate cancer without treating it. It does not involve regular biopsies or other frequent testing. Watchful waiting is best used for men with prostate cancer who do not want or cannot have treatment therapies, especially those men with other life-threatening medical conditions.

The main benefit of watchful waiting is that it avoids many treatment and surveillance-related risks, problems and side effects. However, with this approach the cancer could grow and spread between follow-up visits and ultimately make it harder to treat. Patients should talk with their doctors about which method is best through "shared decision-making."

Dr. Danil Makarov is a urologist focused on caring for men with prostate cancer with NYU Langone Medical Center in New York City.

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