GP Update

Watchful waiting and active surveillance

It’s important to understand the difference between watchful waiting and active surveillance in order to make an informed decision about a patient’s prostate cancer treatment plan

Dr Chris Parker, Consultant Clinical Oncologist, with a patient

Dr Chris Parker, Consultant Clinical Oncologist, with a patient

Because prostate cancer often grows very slowly, some men might never need treatment. Therefore approaches known as watchful waiting or active surveillance are often recommended.

Active surveillance

This means regular, very close monitoring of the cancer so that the patient can be offered curative treatment if the cancer progresses. This is suitable for most men with low risk prostate cancer. Close monitoring is required, with PSAs, regular MRIs and sometimes repeat biopsies. Treatment (surgery, radiotherapy or brachytherapy) is offered if and when the cancer progresses.

Watchful waiting

This term is used to describe a non-intensive form of follow-up that rarely involves tests and relies more heavily on changes in a patient’s symptoms to identify if treatment is needed. This is a non-curative strategy for patients who have multiple comorbidities or a short life expectancy. Palliative treatment is only advised if the patient develops symptoms from the primary cancer or the metastases.

Symptoms to look out for:

  • Bone pain
  • Progressive problems with passing urine
  • Deteriorating renal function

It’s important for GPs to know the different treatment intents of the two strategies, which are sometimes confused.

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