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If your cancer is not causing any symptoms, is growing slowly, or is small and only in your prostate, your physician may suggest active surveillance or watchful waiting instead of treatment.
Active surveillance means your physician closely monitors your cancer with prostate-specific antigen (PSA) tests, digital rectal exams (DREs), imaging studies and biopsies. Watchful waiting involves less testing. You and your physician watch for symptoms. If a change suggests your cancer is growing or turning more aggressive, your physician will talk with you about next steps. A 2025 JAMA review of prostate cancer by Fred Hutch Cancer Center and University of Washington researchers observed that one-third of patients with localized prostate cancer are appropriate for active surveillance.
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How Active Surveillance or Watchful Waiting Are Part of a Prostate Cancer Treatment Plan
Active surveillance and watchful waiting play an important role for many men with prostate cancer that was diagnosed at an early stage and is at low risk for getting worse. If that’s you, these options offer you a way to put off treatment — and the potential side effects — until you truly need it. Instead, you keep living life, knowing you and your care team are keeping an eye on your health. Some men might never need treatment.
Researchers at Fred Hutch study active surveillance, including the long-term outcomes for patients. A study published in JAMA in 2024 followed patients on active surveillance for 10 years after diagnosis.
“This study should reassure people with prostate cancer that, with a lower risk cancer, they don’t need to receive treatment right away. By utilizing active surveillance, patients visit the clinic for regular exams and occasional biopsies and PSA tests, and many can avoid invasive treatments altogether,” said Lisa Newcomb, PhD, a cancer prevention researcher at Fred Hutch. Newcomb is deputy director of the study, Canary Prostate Active Surveillance Study (CanaryPASS).
This approach may also make sense if you’re older — simply because of your age or because you have other health conditions that mean you aren’t a candidate for other types of treatment. Prostate cancer can take 10 or more years to become life threatening. So, if you already expect to live less than 10 years, you might want to talk with your care team about this option. It might be a better choice for you than going straight to surgery, radiation therapy or other types of treatment.
Why Choose Fred Hutch for Active Surveillance or Watchful Waiting for Prostate Cancer
All treatment decisions need to be weighed carefully. At Fred Hutch, our prostate cancer experts know which factors matter most when deciding what to recommend. If your care team says active surveillance or watchful waiting is an option for you, they will explain why. We’re here to tell you about all your options and answer your questions so you can decide what is right for you and your family.
“The goal of active surveillance for prostate cancer is to reduce unnecessary treatments and side effects among those diagnosed with lower risk cancer while avoiding undertreatment of aggressive disease,” said Daniel Lin, MD, prostate cancer researcher and professor of urology at Fred Hutch and UW Medicine, and principal investigator of CanaryPASS.
Out of 100 patients who start active surveillance, 50 will go on to have treatment within the first 10 years. “But half are still free of being treated,” said Lin. If you do need treatment over time, Fred Hutch offers all standard therapies for prostate cancer as well as clinical trials that give you early access to new approaches.
Our researchers are working on new ways to tell which men need more monitoring during active surveillance and which can cut back so there’s less impact on their daily life.
Because you aren’t receiving active treatment, there are no direct side effects of these approaches. There are some risks or downsides, such as:
- You must see your care team regularly for the rest of your life to monitor your condition. This takes up your time, and some people might find it stressful.
- You might feel uneasy not treating the cancer, even if your care team is confident in this approach in your case.
- There’s a small chance your cancer might grow or spread more quickly than your care team expects.
Talk with your Fred Hutch care team about the benefits and risks of every treatment option. We’re here to design a treatment plan that meets your needs.
At Fred Hutch, we tailor your care to you, guided by the latest science. So, your monitoring schedule may not be the same as someone else’s.
According to guidelines from the National Comprehensive Cancer Network, an active surveillance schedule might include:
- PSA test one to two times per year
- DRE one time per year
- Magnetic resonance imaging (MRI) every one to two years
- Biopsy every two to five years
Watchful waiting typically involves fewer visits. You might only need to see your physician one or two times a year unless you notice changes sooner.