Watchful waiting for prostate cancer

Last medical review:

Many men diagnosed with prostate cancer don't need to be treated right away. This is because most prostate cancers grow slowly and are unlikely to spread outside of the prostate. Older men with prostate cancer that has a very low risk of growing quickly or spreading may be offered watchful waiting. During watchful waiting, no routine tests are done. If symptoms develop, treatment may be used to relieve symptoms. The goal of any future treatment is not to cure the cancer but to control the symptoms (called palliative treatment).

Using watchful waiting helps avoid unnecessary routine testing and side effects that can happen with treatments such as surgery or radiation therapy. Watchful waiting may be used for older men with other serious or life-threatening illnesses who are expected to live less than 5 years.

Who is treated with watchful waiting

You may be offered watchful waiting if:

  • the cancer isn't causing any symptoms
  • the cancer is only in the prostate but you have health problems and can't have treatment
  • you are older and have serious health problems, so your life expectancy is less than 5 years

Expert review and references

  • Peter Chung, MBChB, FRCPC
  • Krista Noonan, MD, FRCPC
  • American Cancer Society. Treating Prostate Cancer. 2019: https://www.cancer.org/.
  • American Society of Clinical Oncology. Prostate Cancer. 2020: https://www.cancer.net/.
  • Tracy, CR. Prostate Cancer. eMedicine/Medscape; 2020: https://emedicine.medscape.com/.
  • Garnick MB (ed.). Harvard Medical School 2015 Annual Report on Prostate Diseases. 2015.
  • Mir MC, Stephenson AJ . Expectant management of localized prostate cancer. Nargund VH, Raghavan D, Sandler HM (eds.). Urological Oncology. Springer; 2015: 41: 719-730.
  • PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment (PDQ®)–Patient Version. Bethesda, MD: National Cancer Institute; 2020: https://www.cancer.gov/.
  • PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment (PDQ®)–Health Professional Version. Bethesda, MD: National Cancer Institute; 2020: https://www.cancer.gov/.
  • National Comprehensive Cancer Network . NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer (Version 3.2020) . 2020 .
  • Princess Margaret Cancer Centre. Princess Margaret Cancer Centre Clinical Practice Guidelines: Prostate Cancer. 2015: http://www.uhn.ca/.
  • Zelefsky MJ, Morris MJ, Eastham JA. Cancer of the prostate. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds.. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer; 2019: 70: 1087-1136.
  • Parker C, Castro E, Fizazi K et al . Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up . Annals of Oncology . 2020 : 31(9): 1119-1134 .