Frequently Asked Questions

Watchful Waiting (Active Surveillance)

Q: I have heard that some men with prostate cancer may not need treatment. Can you explain?

A: Correct. When we evaluate men, we first divide them into two groups: (1) those with aggressive disease who need treatment and (2) those whose cancer can just be monitored with no treatment unless needed. This is called Watchful Waiting or Active Surveillance.

Q: How can anyone be told they have cancer but then do nothing about it, can you tell me more about watchful waiting?

A: Watchful Waiting does not mean doing nothing. It means postponing treatment until a later time if treatment is ever needed. You are not ignoring the cancer but are monitoring it, watching it. And, if you get too nervous about watching your disease, you can always change your mind and be treated.

Q: Who can have Watchful Waiting?

A: Men with very low risk cancer, a subset of Low risk men. The low risk group means men with a Gleason score of 3+3=6, PSA less than 10 and stage T1c or T2a. Very low risk are men with this same criteria except they must have only stage T1c, no more than two needles with cancer out of the standard 12-needle biopsy, and the most cancer in any one needle can be no more than half of that needle. These very low risk men are candidates for Watchful Waiting.

Q: How is Watchful Waiting done?

A: After a 12-needle biopsy shows very low risk prostate cancer, instead of treatment, the cancer is monitored by getting a PSA test every six months and repeat the prostate biopsy, either 12-needle or MRI fusion, one year later no matter what the PSA does. Then PSA checks are continued every six months and another prostate biopsy is done 2-4 years later. However, if at any time the PSA starts to significantly rise, the prostate biopsy is repeated no matter what the length of time has been since the first biopsy. If the cancer gets worse, then undergo treatment. This is basically how you do Watchful Waiting.

Q: Why do Watchful Waiting?

A: Many men develop prostate cancer but most men do not die of this disease. Men in the Very Low Risk group are those who rarely die. Watchful Waiting is to prevent you from undergoing a treatment for cancer that probably will never bother you during your natural lifespan. And to avoid the risks of complications such as urinary incontinence (leaking urine) or becoming sexually impotent.

Q: When you are following men with Watchful Waiting, how often does the cancer progress?

A: That subject is still being studied, but based on the information we have, about 30-40% of men will undergo treatment within 10 years either because the cancer progresses or men get too nervous and want to be treated.

Q: How much research has been done on Watchful Waiting?

A: Lack of long-term research, 15-20 years, is the major risk issue of Watchful Waiting. There have not been any long-term studies for men in very low risk groups. We do have 10 year data on observing men with Watchful Waiting, but still it is a small number of men.

Q: Have any men died due to prostate cancer who were doing Watchful Waiting?

A: Yes, but this is very uncommon.

Q: If you had very low risk prostate cancer yourself, would you undergo Watchful Waiting?

A: Yes, without question. Why undergo a treatment that may never be needed or at least could be postponed?

Q: Am I a candidate for Watchful Waiting?

A: No. You have a moderate risk prostate cancer based on your Gleason score 4+3=7. You are under no rush to undergo treatment and can take several months to decide what you want to do, but I would not postpone treatment for your particular case of prostate cancer beyond six months from the time of your biopsy.

Q: What percent of men fall into the very low risk group?

A: We don’t really know, but it may be as many as ¼ of men newly diagnosed with prostate cancer could undergo Watchful Waiting. Watchful Waiting makes a lot more sense than to stop PSA testing for prostate cancer as some doctors have suggested. It is better to find out what type of prostate cancer you are dealing with and either treat it or watch it.