Apples to apples-prostates to prostates

Watchful waiting for prostate cancer

Watchful waiting is a treatment choice for some older men who learn they have prostate cancer in their later years. It means that you and your doctor will watch your cancer to see if it causes any symptoms or appears to be growing. It may seem odd to have cancer and not treat it, but sometimes waiting is the best choice because of the side effects of treatment.

Unlike many other cancers, most prostate cancer grows very slowly. Slow-growing prostate cancer does not normally cause symptoms, so it is possible to have prostate cancer for years without ever knowing it.

During this time, you are aware that you have been diagnosed with prostate cancer, and you are choosing to avoid or delay the side effects of surgery or radiation treatments, which can include bladder problems and erection problems.

You will have regular digital rectal exams and PSA tests during this time. You may have another prostate biopsy during the first year of watchful waiting, and then as often as your doctor recommends. As long as there is no change in your cancer, you may continue watchful waiting. If the cancer begins to grow rapidly or spread, you may consider other treatment.

If you choose watchful waiting, you are taking a chance that your cancer will spread and become incurable during that time. But this is not common.

If your prostate cancer is faster-growing (higher-grade), or if you are young and in good health, your doctor probably will recommend other treatments. Each type of prostate cancer treatment has its advantages and disadvantages, and it is important that you and your doctor consider both when making your treatment decisions.

What To Expect After Treatment

Watching and waiting sometimes continues for years. In other cases, tests eventually show that the cancer is growing and needs to be treated.

Why It Is Done

Prostate cancer is typically a slow-growing cancer. Although most men will get prostate cancer if they live long enough, almost all will die of other causes. If your cancer is caught before it has spread and it is a low-grade or slow-growing cancer, you may choose to watch and wait rather than have surgery or radiation.

Some men choose to watch and wait because they have other medical conditions, such as a heart condition or diabetes, that may make more aggressive treatment impossible or a physical hardship.

Waiting may be an option for men who believe they may be within 10 years of death because of their age or their health. For all these men, the risks of complications and the possible side effects of treatment may be reason to wait.

How Well It Works

Men who have newly diagnosed and slow-growing prostate cancer may choose to wait in order to take more time to make decisions about more aggressive treatment.

Compared with surgery, watchful waiting for early prostate cancer lowers a man’s chances of living longer than 10 years. But most men do live longer than 10 years, whether they get treatment or not. 1

  • Of men who choose watchful waiting for early prostate cancer, about 85% live longer than 10 years. (This means that 85 out of 100 men live longer than 10 years, and 15 out of 100 die within 10 years.)
  • Of men who have surgery for early prostate cancer, about 90% live longer than 10 years. (This means that 90 out of 100 men live, and 10 out of 100 die.)


Watching and waiting may be a reasonable choice for men who have early prostate cancer that is slow-growing. It may also be a reasonable choice for men who have other serious medical problems. But watchful waiting requires regular checkups to monitor your cancer.

By choosing to wait, you are choosing not to remove a cancer that has the potential to be cured and that may eventually cause your death. Low-grade prostate cancer will continue to grow if it is not treated, and the time may come when more aggressive treatment becomes necessary.

What To Think About

When prostate cancer is discovered very early because of a PSA test, symptoms usually do not appear for at least 10 years. This means that if your prostate cancer is small and slow-growing, you may have a few years to decide about starting treatment or keeping up with watchful waiting.

Early prostate cancer does not usually cause symptoms, but some men do have problems urinating. If you are having symptoms and have not yet had treatment, this is a time to talk to your doctor about treatment.

If you are in your later years or have another long-term illness, watchful waiting is a good choice for prostate cancer. If you are young, there are better choices than watchful waiting for treating prostate cancer.

Complete the special treatment information form (PDF)(What is a PDF document?) to help you understand this treatment.

My thoughts

Today a patient told me, after I told him that his biopsy showed prostate cancer, that at lunch one of his buddies said, “I am more afraid of a four-foot putt, than I am of prostate cancer. “Another chimed in,”People die with it not of it.” I’d be a rich man if I had a nickle for the times I have heard this flawed misconception that men have about prostate cancer. It is true that many more men are diagnosed yearly(200,000 or so) of prostate cancer than die of it (30,000 or so). The key is apples to apples and prostates to prostates. You have to have the biopsy to know your cancer. The key to the biopsy is the Gleason’s score and the volume of the biopsies positive. Education of the male and the public regarding this is paramount. Low Gleason’s, low volume good-High Gleason’s and high volume-bad.

Surveillance with good stuff might be smart-Surveillance with the bad stuff probably not. What your uncle Bob did for his cancer may not be the thing to do for your cancer.

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