What did the Dana-Farber studies actually show about prostate cancer and watchful waiting or active surveillance? How reliable and applicable are those findings?
Quick Answer
Dana-Farber researchers have published work supporting observation, especially active surveillance, as a reasonable approach for carefully selected men with low-risk localized prostate cancer.
The studies did not show that giving androgen prevents prostate-cancer spread. In fact, prostate cancer is generally driven by androgen signaling, and treatment for advanced disease commonly works by lowering testosterone or blocking androgen-receptor signaling.
The practical lesson is that some low-risk prostate cancers can be monitored safely rather than treated immediately, while intermediate-, high-risk or metastatic cancers require a different treatment approach.
What Did the Dana-Farber Research Actually Study?
The older version of this page appears to have confused several different concepts.
Dana-Farber and Massachusetts General Hospital investigators published research examining whether men with low-risk localized prostate cancer could reasonably choose observation rather than immediate surgery or radiation.
In a 2010 analysis led by Dana-Farber researchers, active surveillance was found to be a reasonable alternative to immediate treatment for retirement-age men with slow-growing, low-risk prostate cancer.
A 2013 Dana-Farber/Massachusetts General Hospital study also concluded that observation could be a reasonable, and in some circumstances cost-saving, alternative to immediate treatment for men with low-risk disease.
Later research from Dana-Farber showed that the use of active surveillance increased substantially in the United States as evidence supporting conservative management became stronger.
Active Surveillance and Watchful Waiting Are Not Exactly the Same
The terms are sometimes used loosely, but medically they describe different strategies.
| Approach | Main goal | Typical monitoring | What happens if cancer changes? |
|---|---|---|---|
| Active surveillance | Preserve the option of curative treatment while avoiding or delaying unnecessary treatment | PSA testing, clinical follow-up, MRI and repeat biopsy according to protocol | Curative treatment may be recommended if the cancer shows evidence of progression or higher-risk features |
| Watchful waiting | Avoid burdensome treatment when life expectancy, age or other illnesses make curative treatment less likely to provide benefit | Usually less intensive monitoring | Treatment is generally aimed at controlling symptoms if they develop rather than curing the cancer |
For a healthy man with low-risk cancer and substantial life expectancy, active surveillance is usually the more relevant term.
Who Is Most Likely to Be Offered Active Surveillance?
Current prostate-cancer guidelines support active surveillance particularly for men with low-risk localized disease.
Risk classification commonly considers:
- PSA level;
- Gleason score / Grade Group;
- clinical tumor stage;
- how much cancer is present in biopsy cores;
- PSA density;
- MRI findings; and
- other pathological or genomic information when appropriate.
For example, a man with Grade Group 1 cancer, PSA below 10 ng/mL and disease confined to the prostate may often be a candidate for surveillance, although the complete clinical picture must be reviewed.
For more detail, see prostate cancer stages and risk assessment.
Does Active Surveillance Mean “Doing Nothing”?
No.
Active surveillance is an organized medical strategy. The purpose is to detect signs that the tumor is becoming more clinically significant while avoiding treatment side effects in men whose cancer may never become dangerous.
A surveillance program may include:
- periodic PSA testing;
- repeat clinical assessment;
- multiparametric prostate MRI;
- repeat biopsy; and
- discussion of treatment if Grade Group, tumor volume or other risk features worsen.
Current AUA/ASTRO guidance recommends active surveillance as the preferred management option for most patients with low-risk prostate cancer.
Why Can Observation Be Appropriate?
Many localized prostate cancers grow slowly. Immediate surgery or radiation can successfully treat localized cancer, but those treatments can also cause urinary, sexual and bowel side effects.
For carefully selected low-risk patients, delaying treatment can preserve quality of life without giving up the possibility of curative treatment if the disease later shows signs of progression.
That is the clinical logic behind the Dana-Farber work.
Did Dana-Farber Show That Lack of Androgen Causes Prostate Cancer?
No. That claim in the original page should not be retained.
Androgens such as testosterone and dihydrotestosterone can stimulate prostate-cancer cells through the androgen receptor.
For decades, one of the main treatments for metastatic prostate cancer has therefore been androgen-deprivation therapy (ADT), which lowers testosterone production or blocks androgen signaling.
Modern treatment often intensifies ADT by adding drugs such as:
- abiraterone;
- enzalutamide;
- apalutamide;
- darolutamide; or
- docetaxel in selected patients.
How Applicable Are the Dana-Farber Findings Today?
The central finding remains very relevant: not every newly diagnosed prostate cancer needs immediate treatment.
In fact, active surveillance has become a mainstream guideline-supported approach for low-risk disease.
However, the decision must be individualized. Surveillance may be less appropriate when there are higher-risk features such as:
- higher Grade Group;
- higher PSA or PSA density;
- more extensive cancer in biopsy cores;
- suspicious MRI findings;
- clinical evidence that disease is extending beyond the prostate; or
- other pathological findings associated with aggressive disease.
This is why “watchful waiting” should not be used as a blanket recommendation for all prostate cancer.
The Dana-Farber research supports a very important modern principle: carefully selected men with low-risk localized prostate cancer can often be monitored safely rather than undergoing immediate surgery or radiation.
The old claim that androgen treatment prevents prostate-cancer spread is incorrect and has been removed. Modern prostate-cancer hormone therapy generally works in the opposite direction by suppressing or blocking androgen signaling.
Relapsed Prostate Cancer With Lung and Bone Metastases
My prostate cancer has spread to nodules in my lungs and has metastasized to my bones. Is there anything that can prolong my life?
Quick Answer
Yes. There are treatments that can prolong survival in many men with metastatic prostate cancer. The best treatment depends on whether the cancer is still hormone-sensitive or has become castration-resistant, what treatments you have already received, your symptoms, your overall health and the molecular features of the cancer.
Modern care may include androgen-deprivation therapy combined with another life-prolonging systemic treatment, chemotherapy, newer androgen-receptor pathway drugs, PARP inhibitors for selected genetic alterations, PSMA-targeted radioligand therapy, radiopharmaceuticals for selected bone-dominant disease, and treatments to protect the bones or relieve pain.
Hello Brian,
Prostate cancer that has spread to the lungs and bones is advanced metastatic disease, and it is serious. But it is important to know that metastatic prostate cancer is treatable, even when it is not usually considered curable.
Many men can live for years with metastatic prostate cancer that is responding to therapy, although the outlook varies greatly from one person to another.
The First Question: Is the Cancer Hormone-Sensitive or Castration-Resistant?
This distinction strongly influences treatment.
Metastatic Castration-Sensitive Prostate Cancer
If the cancer still responds to lowering testosterone, modern treatment generally uses androgen-deprivation therapy plus an additional treatment rather than ADT alone for men who are fit enough.
Depending on the clinical situation, this may include:
- abiraterone;
- enzalutamide;
- apalutamide;
- darolutamide;
- docetaxel; or
- selected combinations of these approaches.
Clinical trials have shown that treatment intensification can improve overall survival compared with ADT alone.
Metastatic Castration-Resistant Prostate Cancer
If the cancer progresses despite testosterone being kept at castrate levels, other treatments may still help.
Options can include:
- androgen-receptor pathway inhibitors;
- docetaxel or cabazitaxel chemotherapy;
- PARP inhibitors for cancers with certain DNA-repair gene alterations;
- sipuleucel-T in selected minimally symptomatic patients;
- radium-223 for selected patients with symptomatic bone-predominant disease;
- PSMA-targeted lutetium-177 therapy in eligible PSMA-positive disease; and
- clinical trials.
You can also review our updated guide to FDA-approved prostate cancer drugs.
Why Genetic and Molecular Testing May Matter
Modern metastatic prostate-cancer care increasingly includes testing for inherited and tumor-specific genetic changes.
Alterations involving genes such as BRCA1, BRCA2 and other homologous recombination repair genes can make some patients eligible for PARP-inhibitor treatment.
PSMA PET imaging can also determine whether a patient may be eligible for PSMA-targeted radioligand treatment.
What Can Be Done for Bone Metastases?
Bone metastases can cause pain, fractures and other complications, but several supportive and cancer-directed treatments are available.
These may include:
- external-beam radiation to painful bone lesions;
- pain medication;
- bone-modifying agents such as denosumab or zoledronic acid in appropriate settings;
- radiopharmaceutical treatment in selected patients;
- calcium and vitamin D management when appropriate; and
- assessment of fracture or spinal-cord-compression risk.
What About Lung Metastases?
Lung metastases indicate visceral metastatic disease and are one factor the oncology team considers when choosing systemic treatment.
The presence of lung metastases does not mean that there is nothing left to do. Treatment is based on the overall metastatic pattern, cancer biology, symptoms and previous therapy.
Can Anyone Predict Exactly How Long a Patient Will Live?
No individual survival time can be predicted accurately from a short online description.
However, it is equally important not to replace medical information with reassurance alone. Modern treatments can delay progression, relieve symptoms and extend survival for many patients with metastatic prostate cancer.
The most useful next step is a prompt review with a medical oncologist experienced in advanced prostate cancer to establish:
- whether the disease is hormone-sensitive or castration-resistant;
- what treatments you have already received;
- current testosterone and PSA levels;
- the extent of bone and visceral disease;
- whether genetic testing has been done;
- whether PSMA PET imaging is appropriate;
- whether you qualify for additional systemic treatment or a clinical trial; and
- what supportive treatment is needed for bone health, pain and quality of life.
Yes, there may be treatments that can prolong life and control the disease even after prostate cancer has spread to the bones and lungs. The appropriate options depend heavily on whether your cancer is still hormone-sensitive, your previous treatments and the molecular characteristics of the tumor.
I would ask your oncology team specifically whether you are receiving the most appropriate treatment intensification, whether genetic testing and PSMA imaging have been completed, and whether you qualify for targeted therapy, radioligand therapy or a clinical trial.
Palliative care can also be introduced alongside active cancer treatment to improve pain control, function and quality of life; it does not mean that cancer-directed treatment has stopped.
Medical References
Dana-Farber Cancer Institute. Study supports active surveillance for low-risk prostate cancer, 2010.
Dana-Farber Cancer Institute. Observation is safe and cost-saving in low-risk prostate cancer, 2013.
Dana-Farber Cancer Institute. Study finds upsurge in active surveillance for low-risk prostate cancer, 2019.
American Urological Association / American Society for Radiation Oncology. Clinically Localized Prostate Cancer Guideline.
National Cancer Institute. Hormone Therapy for Prostate Cancer.
National Cancer Institute. Prostate Cancer Treatment (PDQ).
Last evidence update: September 2026.