After a prostate cancer diagnosis, treatment is often the first step on the path to recovery. So you may feel surprised if your doctor takes a different approach. For example, they may not immediately come up with a treatment plan for the disease.

Radiation, surgery, and chemotherapy can treat cancer. But your doctor may conclude that treatment isn’t necessary at the time. Instead, they may recommend watchful waiting.

This approach can be unnerving for some people. It’s important to understand what it is, how it works, and whether it’s the right choice for you.

What is watchful waiting?

Watchful waiting delays cancer treatment. It monitors the disease over a period of time, whether that time is weeks, months, or years. Treatment begins only when necessary.

This may seem like an unusual approach to treating cancer. Unlike other types of cancer, prostate cancer can be slow-growing. This means the tumor remains small for an extended period of time. It may never grow to the point where it affects your health.

You’ll remain under a doctor’s care during watchful waiting. During periodic follow-up appointments, your doctor will check the status of your cancer. Later tests may show cancer growth or that the cancer has begun to spread. At this point, your doctor can decide to begin cancer treatment.

When to follow up with your doctor

If you don’t receive immediate treatment for prostate cancer, you may fear the cancer growing and spreading fast. Discuss these concerns with your doctor. The frequency of follow-up visits at this stage vary, but might be every 6 or 12 months.

During these appointments, your doctor may ask about your symptoms and overall health. The presence of symptoms, plus the results of a physical examination, can decide whether to continue watchful waiting. Or your doctor may decide to run more tests to check for cancer growth.

Also, your doctor may complete a second prostate-specific antigen (PSA) blood test. This screens for PSA, a protein produced by the prostate gland. The test checks to see how much PSA is in your bloodstream. If your PSA level is higher than previous tests, this could show cancer growth.

You may also receive a digital rectal examination and a urine test during these visits. These can assess urinary function and analyze tumor size.

Assist your doctor by mentioning any changes in your condition during watchful waiting. This is crucial as your cancer could begin growing before a scheduled follow-up visit.

These changes include:

  • urinating more often, particularly at night
  • problems urinating
  • blood in the urine
  • back or bone pain
  • unexplained weight loss
  • leg swelling

The benefits of watchful waiting

Watchful waiting is an option for cancer that isn’t growing or spreading. You can avoid many of the harmful side effects of cancer treatments. Even when treatments are effective, side effects may include anemia, appetite loss, constipation, fatigue, erectile dysfunction, and urinary problems.

In some situations, the cancer isn’t spreading and unlikely to cause harm. It’s unnecessary to put your body through harsh treatments in these cases. Your doctor may also delay treatment if you have another health issue that limits your life expectancy.

Who is a candidate for watchful waiting?

Not everyone is a candidate for watchful waiting. Your doctor will decide to use this treatment option on a case-by-case basis. They can recommend this option after diagnosing the cancer, assessing the size of the tumor, and confirming the location of the tumor. The tumor may be localized within the prostate. Or, it might’ve already spread to nearby organs and tissue.

Doctors recommend watchful waiting when cancer isn’t causing any symptoms and hasn’t spread. But treatment is necessary for fast-growing or larger tumors.

Some people are uncomfortable with this option because there’s no actual treatment. Keep in mind that watchful waiting is one option, but not the only option.

If, after a diagnosis, your doctor suspects that the cancer may not become a problem for a while, you and your doctor can consider watchful waiting. But if you’d prefer to treat the disease instead, talk with your doctor to discuss the best course of action. This may include surgery, chemotherapy, or radiation. These therapies can do their best to kill cancer cells, but may cause side effects.

Also, consider getting a second opinion about treatment. One doctor may recommend watchful waiting, while another doctor may recommend treatment.

Outlook

Watchful waiting is a viable treatment option in some prostate cancer cases. But you and your doctor must decide whether this approach works for you. If you feel watchful waiting is too risky, discuss possible treatment options with your doctor. And if you choose watchful waiting, make sure you know how to recognize symptoms of progressive prostate cancer. This way, you can begin treatment in the event that your cancer begins to spread.