Watchful waiting, also called expectant therapy, is sometimes recommended for patients who have a low stage prostate cancer and no symptoms, or are elderly, or sick with other medical problems. Watchful waiting means that you won’t receive any specific treatment for prostate cancer, unless careful monitoring reveals that your cancer is growing.

The rationale for this approach is that many older men harbor small cancers within their prostate, but only a small percentage of these men will develop symptoms or problems from their cancer. In the majority, the cancer remains asymptomatic throughout their lifetime. For such a slow-growing cancer, the risks and side effects of the other possible treatments for prostate cancer (such as medication, surgery, and radiation therapy) may not seem worthwhile as compared with the low risk of the growth of prostate cancer. Studies from Europe have suggested that watchful waiting is a reasonable approach in older patients with small, asymptomatic cancers.

The argument against watchful waiting is that some cancers will grow and cause problems, and it can be difficult to predict which ones will do so. As with all treatment options, you should discuss the watchful waiting approach with your doctor to determine if it is right for you.

Careful Monitoring

Some of the monitoring procedures your healthcare provider will follow include:

  • Regular prostate exam (through digital rectal exam)
  • Follow-up transurethral ultrasound exams
  • Periodic measurements of blood PSA levels

Your doctor will decide on an appropriate interval for these monitoring strategies, depending on your age, general medical condition, and information from staging and grading of your tumor.

When to Contact Your Health Care Provider

If you choose watchful waiting, it is important to pay close attention to any changes in your health. Call your doctor if you experience any of the following:

  • A pain that doesn't go away, especially if it's always in the same place
  • New or unusual lumps, bumps, or swelling
  • Nausea, vomiting, diarrhea, or loss of appetite
  • Unexplained weight loss
  • A fever or cough that doesn't go away
  • Unusual rashes, bruises, or bleeding
  • Any symptoms that you are concerned about