When grown in large aggregations, the totem pole cactus is extremely drought tolerant. However, solitary specimens require more frequent irrigation – up to once every 2-3 weeks in summer. Younger and smaller species must be watered more often. Additionally, this species should be planted in a porous, rich, sandy or gravelly soil with a pH between 6.1-7.8. To prevent root-rot, ensure that cactus-soil is well-draining, and add perlite or coarse sand if needed. Replenish with fresh substrate every few years, to encourage growth. Provide as much full sun and direct light as possible in order for species to thrive. It may be necessary to use a grow-light for indoor specimens, as the totem pole cactus will suffer under even partial shade.
No seeds are produced by P. schottii f. monstrosus, and it is unknown if the flowers also develop the edible red fruits of the straight species. Therefore, because P. schottii f. monstrosus only produces sterile flowers - if at all - the only method of propagation is through woody or softwood stem cuttings. Take cuttings in spring or summer, allow to fully callous before planting, and root at a minimum temperature of 68°F. However, for mature plants, temperatures down to 20°F - USDA hardiness zones 9a to 10a - are tolerated. This species is less frost tolerant than the straight species, and should be covered or taken indoors during the colder months.