TraHi, I’m Dr. Scholz.


A common question we get at the PCRI is “What’s the difference between active surveillance and watchful waiting?” They sound sort of the same. You’re just monitoring prostate cancer; if something comes up you treat it.

Well, they’re not the same.

Watchful waiting preceded active surveillance. Watchful waiting has been around for decades. Basically watchful waiting means doing nothing. Men as they get older can contract low-grade cancers, and it has been known for a long time that prostate cancer takes a long time to spread. So watchful waiting consisted of sending people home with the following instructions: “Give me (the doctor) a call if your bones start to hurt. We’ll put you on hormone therapy or cut off your testicles and that will control the disease if your bones start to hurt.” That was watchful waiting. Sounds horrible, but interestingly since prostate cancer is such a low-grade process, the incidence of men progressing to painful bone metastasis was pretty rare, and so watchful waiting say in an 80 year old for most men paid off and they didn’t have to go to the doctor all the time.

I think active surveillance has vastly improved upon that original stance. Active surveillance is based on the idea that you can watch localized prostate cancer closely and if there’s a change or if the disease progresses you can treat it and cure it before it spreads. This means that the idea of forgoing treatment can be extended even to young men, and young men can be watched and then treated if the cancer starts to behave badly. And of course this treatment is before the cancer spreads.

So there’s a vast difference between active surveillance and watchful waiting even though sometimes less-sophisticated patients and doctors will use these terms interchangeably; they’re not interchangeable.

Is anyone still doing watchful waiting?

Yes, this is popular particularly in Scandinavia and in certain cases here in the United States in very elderly men with very small prostate cancers. In those individuals the chances of the cancer spreading is so small they don’t even need to be watched.