Watchful waiting, and how it differs from active surveillance

NICE NG131 defines watchful waiting as part of a strategy for controlling rather than curing prostate cancer, for people with localised disease who do not ever wish to have curative treatment or for whom it is not suitable. It avoids surgery and radiotherapy altogether and relies on deferred hormone therapy if the disease progresses. Follow-up can be in primary care where the local multidisciplinary team and the primary care organisation have agreed a protocol, with PSA measured at least once a year, and anyone on watchful waiting whose PSA rises rapidly or who develops bone pain should be reviewed by a member of the urological cancer team. Bone scans are offered to people who are asymptomatic but at high risk of bone complications when hormone therapy is being deferred.

Active surveillance is the opposite intention. It is a monitoring programme with PSA, repeat MRI and repeat biopsy designed to catch a cancer that is changing early enough to still cure it, and NG131 offers it in Cambridge Prognostic Group 1, as one of three equal choices in group 2 and as an option in group 3 for people who decline immediate radical treatment, with a protocol that includes multiparametric MRI at 12 to 18 months. The difference matters because the two are offered to different people for different reasons, and a man told he is being watched should know which of the two he has agreed to.