{"entity":{"id":"watchful-waiting","kind":"term","name":"Watchful waiting, and how it differs from active surveillance","aka":["watchful waiting","watch and wait prostate","deferred hormone therapy","conservative management prostate"],"tldr":"Two things that sound the same and are not. Active surveillance monitors a cancer closely so it can still be cured if it grows. Watchful waiting gives up the attempt at cure from the start and treats symptoms if and when they appear.","summary":"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.\n\nActive 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.","asOf":"2026-09-25","wikipedia":"https://en.wikipedia.org/wiki/Watchful_waiting","links":[{"label":"NICE NG131: prostate cancer, diagnosis and management (recommendations, including the Cambridge Prognostic Group table at 1.2.15)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations"},{"label":"Lymphoma Action: active monitoring (watch and wait)","url":"https://lymphoma-action.org.uk/information-and-support/lymphoma-treatment/active-monitoring-watch-and-wait"},{"label":"Ardeshna et al., rituximab versus a watch and wait approach in asymptomatic advanced follicular lymphoma, Lancet Oncology 2014 (379 patients)","url":"https://doi.org/10.1016/S1470-2045(14)70027-0"}],"tags":[],"related":["active-surveillance-term","cambridge-prognostic-group","hormone-therapy","psa"],"cancers":["prostate","prostate-low-risk","follicular-lymphoma","marginal-zone-lymphoma","malt-lymphoma","splenic-marginal-zone-lymphoma","nodal-marginal-zone-lymphoma","waldenstrom","mantle-cell-lymphoma","nodular-lymphocyte-predominant-hodgkin-lymphoma","non-hodgkin-lymphoma"],"sections":["surgery"],"technologies":["active-surveillance"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["cambridge-prognostic-group","psa"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["Lymphoma: Lymphoma Action calls this active monitoring and lists the diseases it is used for, namely follicular lymphoma other than grade 3B, the marginal zone lymphomas, Waldenstrom macroglobulinaemia, chronic lymphocytic leukaemia and small lymphocytic lymphoma, some mantle cell lymphoma and nodular lymphocyte predominant Hodgkin lymphoma, and says it is not appropriate for any aggressive lymphoma. It means one to four check-ups a year with examination and blood tests, a scan only where growth is suspected, and treatment when the marrow or an organ is affected, when nodes or the spleen grow quickly or appear in new places, when fever, night sweats and weight loss appear, or when symptoms become difficult to live with."],"category":"Treatment jargon"},"route":"/terms/watchful-waiting/","neighbours":{"term":[{"id":"active-surveillance-term","kind":"term","name":"Active surveillance and observation","route":"/terms/active-surveillance-term/"},{"id":"cambridge-prognostic-group","kind":"term","name":"Cambridge Prognostic Group (CPG 1 to 5)","route":"/terms/cambridge-prognostic-group/"},{"id":"hormone-therapy","kind":"term","name":"Hormone therapy","route":"/terms/hormone-therapy/"},{"id":"lymphoma-living-indolent-lymphoma","kind":"term","name":"Living with an indolent lymphoma rather than being cured of one","route":"/terms/lymphoma-living-indolent-lymphoma/"},{"id":"psa","kind":"term","name":"PSA (prostate-specific antigen)","route":"/terms/psa/"},{"id":"lymphoma-living-scanxiety-and-surveillance","kind":"term","name":"The surveillance schedule, and the evidence that routine scans do not find relapse first","route":"/terms/lymphoma-living-scanxiety-and-surveillance/"},{"id":"lymphoma-decision-watch-and-wait","kind":"term","name":"Watch and wait in follicular lymphoma: being told you have cancer and that nobody will treat it","route":"/terms/lymphoma-decision-watch-and-wait/"},{"id":"lymphoma-tx-watch-and-wait","kind":"term","name":"Watch and wait in lymphoma: when the right treatment is none yet","route":"/terms/lymphoma-tx-watch-and-wait/"}],"cancer":[{"id":"malt-lymphoma","kind":"cancer","name":"Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)","route":"/cancers/malt-lymphoma/"},{"id":"follicular-lymphoma","kind":"cancer","name":"Follicular lymphoma","route":"/cancers/follicular-lymphoma/"},{"id":"prostate-low-risk","kind":"cancer","name":"Localised prostate cancer, very low and low risk","route":"/cancers/prostate-low-risk/"},{"id":"mantle-cell-lymphoma","kind":"cancer","name":"Mantle cell lymphoma","route":"/cancers/mantle-cell-lymphoma/"},{"id":"marginal-zone-lymphoma","kind":"cancer","name":"Marginal zone lymphoma","route":"/cancers/marginal-zone-lymphoma/"},{"id":"nodal-marginal-zone-lymphoma","kind":"cancer","name":"Nodal marginal zone lymphoma","route":"/cancers/nodal-marginal-zone-lymphoma/"},{"id":"nodular-lymphocyte-predominant-hodgkin-lymphoma","kind":"cancer","name":"Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)","route":"/cancers/nodular-lymphocyte-predominant-hodgkin-lymphoma/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"splenic-marginal-zone-lymphoma","kind":"cancer","name":"Splenic marginal zone lymphoma","route":"/cancers/splenic-marginal-zone-lymphoma/"},{"id":"waldenstrom","kind":"cancer","name":"Waldenström macroglobulinaemia","route":"/cancers/waldenstrom/"}],"section":[{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"technology":[{"id":"active-surveillance","kind":"technology","name":"Active surveillance","route":"/technologies/active-surveillance/"}],"trial":[{"id":"ielsg-19","kind":"trial","name":"IELSG-19","route":"/trials/ielsg-19/"},{"id":"mosun-lbt-fl","kind":"trial","name":"Mosunetuzumab against rituximab in low tumour burden follicular lymphoma","route":"/trials/mosun-lbt-fl/"},{"id":"prima-follicular","kind":"trial","name":"PRIMA","route":"/trials/prima-follicular/"}],"idea":[{"id":"lymphoma-ev-fixed-duration-chemotherapy-free-first-line","kind":"idea","name":"Fixed-duration, chemotherapy-free first-line treatment for the indolent lymphomas","route":"/ideas/lymphoma-ev-fixed-duration-chemotherapy-free-first-line/"}]}}