Active Surveillance vs Watchful Waiting: A 2025 Guide for Prostate Cancer Patients

Active Surveillance and Watchful Waiting are two ways to manage prostate cancer without immediate surgery, radiation, or other treatments. Many prostate tumors grow very slowly and might never cause serious harm in a man’s lifetime pmc.ncbi.nlm.nih.gov. Aggressive treatments can have significant side effects like urinary or sexual problems. These monitoring approaches allow doctors to delay or avoid treatment unless the cancer shows signs of changing pmc.ncbi.nlm.nih.gov. By doing so, men can maintain their quality of life without shortening their survival www1.racgp.org.au. In fact, studies have found that carefully selected patients who choose monitoring have similar long-term survival as those who treat the cancer right away. Active surveillance has become much more common in recent years. About 60% of men with low-risk prostate cancer now start on active surveillance, up from around 26% in 2014 pubmed.ncbi.nlm.nih.gov. This rise reflects a growing recognition that immediate treatment isn’t always needed for slow-growing cancer. Leading medical groups now recommend active surveillance as the preferred approach for most men with low-risk prostate cancer cancer.gov. By holding off on surgery or radiation, many men avoid side effects like incontinence (loss of bladder control) or erectile dysfunction while still keeping the option to cure the cancer if it begins to progress. Decisions should always be personalized, but the trend shows doctors and patients are increasingly comfortable with careful monitoring.

What is Active Surveillance?

Active Surveillance is a structured monitoring plan for prostate cancer. It means no immediate treatment – instead, the cancer is watched closely with regular tests. The goal of active surveillance is to catch any sign of growth or change early and treat the cancer only if it starts to become more aggressive pmc.ncbi.nlm.nih.gov. In other words, it is done with curative intent: the plan is to cure the cancer later if and when it becomes necessary. Many studies show that for men with very low-risk or low-risk prostate cancer, active surveillance does not reduce their chance of survival compared to treating the cancer right away. It helps avoid overtreatment – treating a cancer that may never have caused harm – and spares the patient from side effects for as long as possible.

Who is it for? Active surveillance is usually recommended for men with localized prostate cancer (cancer confined to the prostate) that is low risk. “Low-risk” generally means the cancer is small, has a low Gleason score (grade group 1, often written Gleason 3+3), and a low PSA level (prostate-specific antigen blood test) – features suggesting it’s unlikely to grow or spread quickly. Guidelines now recommend active surveillance as the best approach for most low-risk prostate cancers. It’s especially considered if a man is expected to live at least 10 more years (is relatively younger or healthy) so that if the cancer does progress later, he can still undergo curative treatment at that time. Active surveillance might also be offered to some men with favorable intermediate-risk cancer (for example, Gleason 3+4) on a case-by-case basis, if they strongly wish to avoid immediate treatment and the disease appears still slow-growing. Doctors will look at all the test results – PSA, biopsy findings, scans – to make sure a patient’s cancer is appropriate for surveillance.

What does Active Surveillance involve? If you are on active surveillance, you will have a predefined schedule of tests and check-ups. The exact plan can vary, but typically you can expect:

Regular PSA blood tests: This is usually done every 3 to 6 months. PSA is a protein made by the prostate; rising PSA levels over time can be a sign the cancer is growing. Your doctor will track your PSA trend closely.
Digital rectal exams (DRE): During some visits (for example, once or twice a year), the doctor may perform a DRE – feeling the prostate with a gloved finger – to check if it feels stable or if there are any new lumps.
Imaging tests: Many doctors now use periodic imaging of the prostate. You might get an MRI scan of the prostate, especially at the start (to get a detailed look at the tumor) and then if there are PSA changes or maybe every couple of years. MRI can help spot growth that might need a closer look.
Follow-up biopsies: A biopsy means taking small samples from the prostate with a needle to examine under a microscope. On active surveillance, it’s common to have a confirmatory biopsy about 6–12 months after starting (to ensure no higher-grade cancer was missed). After that, additional biopsies may be done every few years, or sooner if something looks suspicious (like a big PSA jump or an MRI finding). Biopsies provide the most direct information about whether the cancer is getting more aggressive (for example, if the Gleason score increases).
Clinic visits: You will see your urologist (and sometimes also a specialist nurse or oncologist) at regular intervals to discuss test results. These visits are an opportunity to review your latest PSA levels, exam findings, and any symptoms or concerns you have.

During active surveillance, you will not feel any different from the cancer itself – early prostate cancer usually has no symptoms. It’s normal to feel well, which can sometimes make it hard to remember you have cancer at all. If any of your test results show a significant change, your doctor will promptly investigate. For example, if your PSA is rising faster than expected, or if a follow-up biopsy finds the cancer grade has increased, it could mean the cancer is becoming more active. At that point, your doctor will talk with you about starting an active treatment (such as surgery or radiation) to cure the cancer while it is still highly curable. The intent is never to ignore the cancer, but to treat it only when there is evidence that treatment is needed.

Quality of life on Active Surveillance: One reason active surveillance is popular is that it lets men avoid treatment side effects for as long as possible. Men on surveillance keep their prostate intact and usually maintain normal urinary and sexual function, since treatments that often affect these functions are delayed. Research on men who choose active surveillance finds that most men do not suffer high anxiety or mental distress from living with untreated cancer pmc.ncbi.nlm.nih.gov. In fact, anxiety levels are often low, and overall quality of life is comparable to (or better than) men who went through immediate treatment, largely because they avoid issues like incontinence or erectile dysfunction. Of course, every individual is different – some men do feel anxious knowing the cancer is still there. If you feel anxious, it’s important to discuss those feelings with your doctor (and we’ll cover coping strategies later in this guide). But many patients take comfort in knowing the cancer is being watched carefully and can be treated if needed, and they appreciate that they’re not dealing with side effects unnecessarily.

What is Watchful Waiting?

Watchful Waiting is another strategy of monitoring prostate cancer without immediate treatment, but it is less intensivethan active surveillance and has a different purpose. The goal of watchful waiting is not to cure the cancer, but to keep an eye on it and preserve quality of life for as long as possible pmc.ncbi.nlm.nih.gov. It is often chosen for men who are older or have other serious health issues – in other words, men for whom the prostate cancer is unlikely to threaten their life before other health factors do. In these situations, aggressive treatments might not prolong life but could seriously affect comfort and day-to-day living. Watchful waiting is a way to avoid or delay any treatment unless the cancer causes symptoms that need addressing.

You might also hear watchful waiting called “observation” or “deferred therapy.” It is different from active surveillance. While active surveillance aims to catch signs of progression early for a potential cure, watchful waiting is a more passive, palliative approach. The mindset is that the cancer will be treated only if it ever causes problems, and then treatment will be focused on relieving symptoms (not necessarily eliminating the cancer).

Who is it for? Watchful waiting is generally considered when a man’s life expectancy is less than about 10 years (due to age or other health conditions), or when the cancer is not likely to be lethal and the burdens of treatment outweigh the potential benefits. It can be applied to patients of any risk level or stage of prostate cancerif curative treatment isn’t a good option. For example, an older man (say in his late 70s or 80s) with a small low-grade tumor might choose watchful waiting because even if the cancer grows slowly, he may never experience problems from it in his lifetime. Alternatively, someone with other severe health problems might opt for watchful waiting because surgery or radiation would be risky or debilitating for them. In some cases, even a man with a more aggressive tumor might be placed on watchful waiting if he isn’t fit for treatment – the approach then would be to manage symptoms if and when they arise. The key is that the focus is on comfort and quality of life, and not exposing the patient to side effects unless absolutely necessary.

What does Watchful Waiting involve? Compared to active surveillance, watchful waiting involves much fewer testsand doctor visits. There usually isn’t a strict schedule for blood tests or biopsies. Instead, the monitoring is “patient-specific” – meaning it’s tailored to the individual’s situation and often just means routine check-ups. Here’s what you can generally expect if you are on watchful waiting:

Periodic check-ups: You will still see a doctor (often your general practitioner or urologist) at intervals – perhaps every 6 or 12 months – just to ask how you’re feeling and if any new symptoms have appeared. These appointments are usually simple office visits.
Minimal tests: Unlike active surveillance, you might not get regular PSA tests. Some doctors might still check PSA occasionally to see the trend, but since the plan isn’t to act on slight increases (unless there are symptoms), PSA is less emphasized. You also won’t be getting routine biopsies or MRIs under watchful waiting. The approach avoids invasive tests unless there’s a clear reason.
Watching for symptoms: The main point of watchful waiting is to monitor for any symptoms of the cancer. Prostate cancer that is confined to the prostate typically causes no symptoms. If it starts to grow or spread, it might cause issues like trouble urinating, bone pain (if it spreads to bones), weight loss, or general fatigue. Under watchful waiting, you and your healthcare team are attuned to any such changes.
Reporting changes: You will likely be instructed to report any new symptoms right away rather than waiting for the next appointment. For example, if you suddenly have difficulty passing urine, start feeling unexplained pain, or any other worrying change, you should inform your doctor. These could be signs the cancer is progressing or affecting your body.
Less frequent interventions: As long as you feel fine and have no symptoms, you continue on watchful waiting. No immediate treatment is given. You are essentially “keeping an eye on things” over the long term pmc.ncbi.nlm.nih.gov.

If the cancer eventually does cause symptoms or complications, the approach will change. At that point, the doctor will recommend starting treatment to relieve those symptoms pmc.ncbi.nlm.nih.gov. This might be hormonal therapy to shrink or slow the cancer (for example, medication to lower testosterone, which prostate cancer needs to grow), or radiation directed at a painful metastasis, or other measures to maintain comfort. Such treatment when given after a period of watchful waiting is considered palliative – meaning its purpose is to control disease effects and improve quality of life, not necessarily to cure the cancer. For instance, if a man on watchful waiting develops bone pain from the cancer spreading, he might receive radiation or medications to reduce pain. Importantly, with watchful waiting the cancer may never reach a problematic stage – many men will remain symptom-free and eventually die with their prostate cancer, not from it. In those cases, they never need any cancer treatment at all.

It’s worth noting that choosing watchful waiting can sometimes be a difficult emotional decision, just like active surveillance. Family members might worry that “nothing is being done” about the cancer. But it helps to remember that this approach is chosen when the risks of treatment outweigh the benefits. The plan is to do something – that “something” is careful observation and maintaining quality of life. If circumstances change, the plan will change accordingly. Doctors do not recommend watchful waiting unless they believe it is a safe and sensible choice for the patient’s specific situation.

Key Differences Between Active Surveillance and Watchful Waiting

Active surveillance (AS) and watchful waiting (WW) are both forms of “observation” management, but they are not the same. They differ in their intent, intensity, and patient selection. Here are the key differences:

Purpose/Intent: Active surveillance is done with the intent to cure the cancer if it starts to worsen. It’s a way to delay treatment, not avoid it forever. In contrast, watchful waiting is done with a palliative intent, meaning the goal is to manage symptoms if they occur, not to cure the disease. Put simply, AS still plans for a possible cure down the line; WW accepts that a cure isn’t being pursued and focuses on comfort.
Monitoring intensity: Active surveillance follows a strict, regular schedule of tests. You’ll have frequent PSA tests, doctor exams, and occasional scans or biopsies to actively check the status of the cancer. Watchful waiting, on the other hand, involves minimal monitoring – there is no fixed schedule of PSA tests or biopsies. Doctors will generally monitor WW patients through routine health check-ups and rely on symptoms to guide action.
When to act: In active surveillance, the doctor will recommend **active treatment (surgery, radiation, etc.) at the earliest sign that the cancer is progressing (for example, if a biopsy shows a higher grade, or PSA rises quickly). The idea is to intervene before the cancer can spread or cause harm, thus still aiming for a cure. In watchful waiting, the doctor will only treat the cancer if and when symptoms develop – meaning the cancer has already caused some issues. Treatment under WW is usually to alleviate symptoms or complications, not to eliminate the cancer.
Patient profile: Active surveillance is mostly offered to men with localized, low-risk cancer who are otherwise in good health and likely to live longer than 10 years. These patients have time to safely wait and see if the cancer grows, and they need to be fit enough to undergo a curative treatment later if needed. Watchful waiting can be chosen by patients with shorter life expectancy (<10 years) or significant other health problems. It’s often used for older men or those with higher-risk cancer who cannot undergo surgery/radiation. In fact, WW “can apply to patients with all stages” of prostate cancer – the common thread is that immediate aggressive treatment isn’t suitable for them.
Psychological aspect: With active surveillance, the patient commits to regular testing and may experience some anxiety while waiting for results (though studies show many cope well). There is an active engagement in one’s care. In watchful waiting, the approach is more hands-off, which for some patients can be mentally easier (fewer hospital visits, less “medicalization” of life), but others might worry about “ignoring” the cancer. Understanding the rationale is key in both cases: AS patients take comfort that the cancer is checked often, WW patients take comfort that they’re avoiding unnecessary treatment and will act if needed.

Despite these differences, both approaches share an important philosophy: avoid treating the cancer unless it’s necessary. Both AS and WW acknowledge that not every prostate cancer needs immediate intervention. This helps many men avoid the side effects of treatment and leads to a better overall quality of life. Both strategies have been studied, and for the appropriate patients, both can be very safe management options with excellent outcomes. For example, even in older men on watchful waiting, research has found that immediate surgery did not significantly improve survivalcompared to observation. And for low-risk patients on active surveillance, long-term studies show no difference in prostate cancer mortalitycompared to those who had early treatment. The key is making sure you fall into the category of patients that benefit from these approaches, and that you are comfortable with the monitoring process.

In summary, think of active surveillance as “active monitoring with an eye toward cure” and watchful waiting as “passive monitoring with an eye toward comfort.” The next sections will discuss how to live with these strategies and offer practical tips for patients and caregivers.

Living with Active Surveillance: Practical Advice

If you are on active surveillance, you are taking a proactive role in managing your cancer. Here are some practical tips and advice for patients (and their caregivers) to navigate active surveillance:

Stick to your schedule: Attend all your scheduled appointments for PSA tests, check-ups, scans, and biopsies. Mark them on your calendar and set reminders. Regular monitoring is crucial – it’s the backbone of active surveillance. Skipping tests could mean missing an early sign that the cancer is changing.
Keep records: Maintain a personal log of your PSA results and other test results. This can help you see trends over time and feel more in control. You can use a notebook or a simple spreadsheet. If something in your results concerns you, discuss it with your doctor. Remember that PSA levels can fluctuate a bit, so one higher reading isn’t always cause for alarm – doctors look at the pattern over time.
Communicate with your healthcare team: Make sure you know who is managing your surveillance – often it’s a urologist, but your regular doctor may also be involved. Don’t hesitate to ask questions (see the list of suggested questions below). If you experience any new urinary symptoms (changes in urine flow, blood in urine, etc.) or other issues, inform your doctor even if it’s between scheduled visits. While symptoms are not expected in low-risk disease, reporting changes promptly is always wise.
Manage anxiety and stay informed: It’s normal to feel anxious at times knowing you have an untreated cancer. Educate yourself (from reliable sources) about prostate cancer and active surveillance – understanding why this approach is safe can ease worries. Many men find that after a few uneventful check-ups, their anxiety decreases. If you find yourself very worried or stressed, talk to your doctor about it. They might refer you to a counselor or a support group. Connecting with other men who are also on active surveillance can be reassuring – they can share how they cope with the “watch and wait” process.
Leverage support from caregivers and family: Make sure your partner or close family understand what active surveillance is. Often, family members fear “nothing is being done.” Explain to them (and involve them in doctor visits if you want) that this is an active plan – it’s doing something very important: monitoring to avoid unnecessary treatment. Caregivers can help by coming to appointments, taking notes, and helping you remember instructions. They can also help keep an eye on your well-being day-to-day. Having your loved ones on board with the plan will give you emotional strength and confidence in the approach.
Maintain a healthy lifestyle: While no specific diet or supplement is proven to stop prostate cancer growth, living healthfully is always beneficial. Eat a balanced diet rich in fruits and vegetables, stay physically active according to your ability, and keep a healthy weight. Some studies suggest that a healthy lifestyle might support better outcomes, but even if it doesn’t directly slow the cancer, it will improve your overall health and energy. Avoid smoking and excessive alcohol. These steps can also help you be in the best possible shape if you ever do need treatment later.
Understand the plan for possible treatment: Talk with your doctor about what the thresholds are for moving to active treatment. For example, ask what PSA change, biopsy result, or other finding would trigger a recommendation to treat. It can be comforting to know that clear criteria exist. Also discuss what treatments are available if that day comes (though you don’t need to decide on a specific treatment unless and until you actually need one). Knowing that effective treatments are “on deck” if needed can help you feel secure that you’re not risking your life by waiting.
Be prepared for biopsies and tests: Some of the monitoring tests, like prostate biopsies, can be uncomfortable or cause temporary side effects (like a bit of bleeding or soreness). Talk to your doctor about what to expect from these procedures. For instance, ask if you’ll have local anesthesia, how to take care of yourself after a biopsy, and what side effects are normal. Being mentally prepared can reduce apprehension. Also, follow any instructions given (like antibiotic use around biopsy time to prevent infection, etc.).
Patience is key: Active surveillance is a long-term game. It could continue for many years. It’s important to remain patient and trust the process. Remind yourself why you chose this route: to avoid unnecessary treatment and side effects. As long as the cancer remains low-risk, you are doing the right thing by monitoring. Many men on active surveillance never need further treatment and live out their lives without the cancer ever becoming a problem.
Stay engaged and positive: Celebrate the fact that each normal check-up is a “win.” It means you’ve bought more time without side effects and the cancer is still under control. Use that time to enjoy life – many patients say that being on surveillance motivates them to live more fully, focus on what they love, and not take good health for granted. It’s okay to acknowledge the psychological challenge, but also take pride in actively managing your health in partnership with your doctors.

Living with Watchful Waiting: Practical Advice

If you are following a watchful waiting approach, your priorities and needs might be a bit different. Here’s some advice to help patients and caregivers when watchful waiting is the chosen strategy:

Know why you chose watchful waiting: It’s important for you and your family to understand the rationalebehind watchful waiting in your case. Perhaps you are of an age or health status where prostate cancer is unlikely to affect your lifespan, or your cancer might be slow-growing and you wish to avoid the hardships of treatment. Remind yourself (and your loved ones) that not treating immediately is a conscious, medically guided choice aimed at keeping you comfortable and maintaining your quality of life. It is not “giving up” on treatment; it’s recognizing that treatment is not needed at this time and may never be needed at all.
Attend routine check-ups: Even though watchful waiting doesn’t involve frequent tests, you should still see your doctor as advised (maybe every 6 or 12 months). Use those visits to discuss how you’re feeling and to do any basic evaluations the doctor recommends (perhaps a PSA test now and then, or a physical exam). Keeping these appointments ensures that a medical professional is keeping an eye on your situation.
Be alert to symptoms: You and your caregiver should watch for any new symptoms that could signal the cancer is progressing. Key things to look out for include: changes in urination (straining to pee, weaker stream, blood in urine), unexplained pain (especially in the back, hips, or other bones), unexplained weight loss, or fatigue. However, try not to obsessively worry about symptoms – just be mindful. Most men on watchful waiting remain symptom-free for a long time, and some never develop symptoms. But if something does change, you want to catch it early.
Report problems promptly: If you do notice a new symptom or a change in your health that could be related to the prostate cancer, inform your doctor sooner rather than later. Don’t wait for your next scheduled visit. A quick phone call to the clinic or an earlier appointment can help assess what’s going on. Sometimes symptoms like bone pain could be due to other causes like arthritis – but it’s important to check. If the issue is due to cancer progression, addressing it quickly (for example, starting medication to relieve bone pain or control tumor growth) can improve your comfort. Prostate cancer that spreads often responds well to treatments like hormone therapy to ease symptoms, so there is usually effective relief available pmc.ncbi.nlm.nih.gov.
Plan for the “what if”: Have a conversation with your doctor (and family) about what will be done if the cancer starts causing trouble. Knowing the plan can make you feel more secure during the waiting period. For instance, your doctor might say, “If you develop symptom X, we will start you on Y medication or refer you to radiation oncology,” etc. It doesn’t mean you want that to happen, but having a plan in place is like having a safety net. It converts a scary unknown (“what if it gets worse?”) into a manageable scenario (“if it gets worse, we’ll do ___”). This kind of future planning is especially important for caregivers too, so they know how to support you if the disease evolves.
Lifestyle and general health: Just as with active surveillance, maintaining a healthy lifestyle is beneficial. Even though you might be older or have other health issues, do what you can in terms of balanced diet and gentle exercise (with your doctor’s approval). It can help you feel better overall. Stay on top of your other medical conditions – managing your blood pressure, diabetes, heart conditions, etc., will contribute to your well-being. Sometimes the other conditions are more likely to affect you than the prostate cancer, so give them due attention.
Address other prostate symptoms: Some men on watchful waiting may have urinary symptoms due to an enlarged prostate (BPH) rather than the cancer itself. If you have any urinary issues like waking up often at night to urinate or a weak stream, discuss them with your doctor. These symptoms can often be managed with medications (unrelated to cancer treatment). Watchful waiting is about not treating the cancer aggressively, but you can and should treat any bothersome symptoms to improve quality of life.
Enlist support: Make sure at least one close friend or family member understands your choice of watchful waiting and the reasons behind it. This person can help advocate for you if needed and provide emotional support. Sometimes, others might pressure a patient to “do something” about the cancer; having your doctor and a caregiver reiterate that watchful waiting is doing something – it’s a medically supervised approach – can be helpful. Support groups (in-person or online) can connect you with other men taking the watchful waiting route. Hearing from those who have been on WW for years without issues can be very reassuring.
Quality of life focus: Since watchful waiting is all about prioritizing quality of life, make sure you are indeed enjoying life! Do the activities you love, spend time with family, and continue hobbies. The knowledge that you’re not undergoing treatment right now means you likely feel physically normal – no recovery from surgery, no radiation side effects, etc. Use that to your advantage: stay active socially and mentally. If in the future you do need some form of therapy, being in good spirits and general health can help you handle it better.
Revisit the decision if circumstances change: Watchful waiting is not a one-way street that you must stay on no matter what. It’s always okay to talk to your doctor about switching strategies if you’re uneasy. For example, if a couple of years pass and you or your family feel more anxious than you expected, you can discuss moving to active surveillance (with more regular checks) or even treatment. Or if a new health issue arises that changes the equation, your doctor might suggest re-evaluating the plan. In short, keep an open dialogue – the plan can be adjusted to what makes you most comfortable. Doctors won’t force you to stick with watchful waiting if you strongly prefer to treat; they will lay out the pros and cons. The best approach is one you feel confident about.

Both active surveillance and watchful waiting require trust in your medical team and in the strategy. It can be psychologically challenging to live with cancer and not “fight” it immediately. But countless patients have done so successfully. They have lived many healthy, fulfilling years without problems from their prostate cancer by using these approaches. The key is staying engaged: even if you’re not actively treating the cancer, you are actively managing your health.

Finally, whether you’re on active surveillance or watchful waiting, never hesitate to reach out to your doctor with questions or concerns. It’s better to ask and get reassurance than to worry in silence. In the next section, we provide a list of important questions you may consider asking your healthcare provider about these monitoring strategies.

Questions to Ask Your Doctor

It’s crucial to have clear communication with your healthcare team when you are considering or undergoing active surveillance or watchful waiting. Here is a structured list of questions you might want to ask, grouped by topic, to help you cover all the important points:

Understanding Your Approach:

Which monitoring approach am I a candidate for, active surveillance or watchful waiting, and why? (Ask your doctor to explain why this strategy is recommended for you based on your cancer’s characteristics and your overall health.)
What does it mean that my cancer is “low-risk” or suitable for monitoring? (Have the doctor clarify your cancer’s stage, Gleason grade, and PSA level in simple terms, and why those indicate it’s safe to hold off on treatment.)
What are the risks if we don’t treat my cancer right now? (Understanding the worst-case scenario can help you appreciate the reasoning. Your doctor can discuss the likelihood of the cancer spreading or causing problems in the near term.)
What are the pros and cons of waiting versus treating immediately in my case? (This lets the doctor summarize the benefits – like avoiding side effects – and the potential downsides or uncertainties of deferring treatment.)

Monitoring and Follow-Up Schedule:

What tests will I need while on active surveillance/watchful waiting, and how often will I need them? (Get a clear outline: e.g., PSA every 6 months, a biopsy next year, etc., or for watchful waiting, maybe just periodic check-ups.)
Will I need repeat biopsies or scans, and how frequently? (Especially important for active surveillance: know if and when another biopsy is planned.)
Who will be in charge of my follow-up? (Ask if the urologist will see you for all visits or if some monitoring can be done by your primary care doctor. Also, if multiple doctors are involved, who is the point person coordinating your care.)
What should I expect at these follow-up appointments? (For example, ask if each visit will include a physical exam, a review of symptoms, or just a quick lab draw for PSA. Knowing the routine can reduce anxiety.)

Signs and Changes to Watch For:

What changes in my test results would prompt a move to active treatment? (For active surveillance: ask about specific triggers like a certain rise in PSA, changes on MRI, or a higher-grade biopsy finding. For watchful waiting: this may be more about symptom development.)
What symptoms should I look out for and report immediately? (E.g., difficulty urinating, bone pain, etc. Having a list of red-flag symptoms will empower you to be vigilant.)
If I notice a new symptom or change, who should I contact and how soon? (Get clear instructions: call the urology clinic, or see your GP, etc., and don’t wait until the next appointment.)
How will we know if the cancer is still under control? (This is a more general question – the doctor can explain what stability means in terms of PSA levels, exam findings, etc., to give you peace of mind about what “no change” looks like.)

Future Plans and Treatment Options:

If the cancer progresses, what are the treatment options at that point? (Have the doctor outline what would be done if surveillance ends – e.g., surgery, radiation, hormone therapy – without going into too much detail, just so you know there’s a plan.)
Will delayed treatment (if needed) still likely cure my cancer? (This is a very important question for active surveillance patients. Doctors can share data that treating at early signs of progression is usually just as effective as treating right away. If you’re on watchful waiting, the question might be more about controlling the cancer if it grows.)
Is there a chance I will never need treatment? (For active surveillance, many men never need intervention, and for watchful waiting, the hope is also that you might never require palliative treatment. It’s good to discuss these probabilities.)
At what point would you recommend switching from active surveillance to watchful waiting, or vice versa? (In some cases, if a man on active surveillance grows older or develops other conditions, the strategy might change to watchful waiting. It’s worth asking if your plan might change over time based on new circumstances.)

Lifestyle and Support:

Are there lifestyle changes I should make while on this monitoring plan? (For instance, ask if there are any dietary recommendations, exercise guidelines, or supplements to take or avoid. Doctors might not have a specific regimen, but they often encourage general healthy habits.)
How can I best support my health and immune system during this period? (This is a way to ask about anything you can do to stay as healthy as possible – stress reduction, nutrition, etc. While not specific to cancer control, it addresses your overall wellness.)
Do you have recommendations for dealing with stress or anxiety related to not treating the cancer immediately?(Your doctor might suggest support groups, counseling, or simply provide reassurance based on their experience with other patients.)
Are there any support groups or resources for patients on active surveillance/watchful waiting? (Often, hospitals have patient education materials or can refer you to local or online groups where you can connect with others in the same situation.)
What can my family or caregiver do to help during active surveillance/watchful waiting? (This invites advice for your loved ones’ role – the doctor might say they should help you watch for symptoms, or just be supportive of your decision, etc.)

These questions are a starting point. Feel free to ask any other questions or express any concerns you have – no question is too small when it comes to understanding your care. It’s often helpful to write down your questions before appointments and even bring a friend or family member along for support. The goal is for you to feel comfortable and confident in your monitoring plan.

Conclusion: Active surveillance and watchful waiting empower many prostate cancer patients to avoid unnecessary treatment and live normally, keeping treatment in reserve for when or if it’s needed. By understanding the differences between these approaches and engaging actively with your healthcare team, you can make informed decisions that align with your values and health goals. Use this guide to inform discussions with your doctors and loved ones. Remember, choosing a monitoring strategy is not “doing nothing” – it is an active choice to manage your cancer in a way that maximizes your quality of life. With regular follow-ups and open communication, you can safely navigate your prostate cancer journey, whether that means continuing to monitor or deciding to treat in the future. Always stay proactive, and reach out for support when you need it. The medical evidence in recent years strongly supports that for the right patient, “watching and waiting” is a wise and effective course.