Prostate Cancer: Active Surveillance

Not every person with prostate cancer needs to be treated right away. In many cases, early-stage prostate cancer will not spread or cause any problems or side effects for a long time, if ever. That’s why your healthcare provider may suggest active surveillance. This is the decision to actively keep track of your prostate cancer over time, instead of treating it right away. This way the side effects of prostate cancer treatment can be delayed without causing you harm. Treatment can then be done later if the prostate cancer changes and is growing larger or causing symptoms.

Active surveillance or watchful waiting (observation)?

Active surveillance is not the same approach as watchful waiting orobservation. You will have more exams, biopsies, and tests over time with active surveillance, but fewer with watchful waiting. Treatment to cure the cancer can readily begin if it starts to grow or spread. Your provider will tell you which approach is best for your cancer and what it means for you.

When active surveillance is a choice

Your healthcare provider will consider several things before offering active surveillance. These include your life expectancy, your overall health status, specifics about your tumor and risk level, side effects of treatment, and your preferences.

Active surveillance may be a choice for you if:

• Your healthcare provider believes that your cancer is growing slowly

• Your cancer is considered lower risk

• You have a small tumor that hasn’t spread

• You have a low Gleason score

• You’re younger and your life expectancy is 10 or more years.

• You're in good health

Who probably should not use active surveillance

Active surveillance may not be a choice for you if:

• You're older with a life expectancy of less than 10 years and have serious health problems

• Your cancer is growing quickly and at a higher risk for spreading

• Your cancer causes symptoms affecting your quality of life

• You have anxiety about living with untreated cancer

What to expect during active surveillance

To see if active surveillance is a good choice for you, your healthcare provider will need more tests to confirm, such as a special MRI, a prostate biopsy, or both. You'll likely see your healthcare provider every 3 to 6 months. At each visit, your provider will likely give you a blood test. This is done to test the level of prostate-specific antigen (PSA) in your blood. You may also have a digital rectal exam but no more than once a year or as needed. You may also have a repeat prostate biopsy and a repeat special MRI periodically. These tests can show signs that the cancer may be growing. 

If your PSA level starts to go up, your healthcare provider will carefully watch how fast it's rising. This rate of change is called the PSA velocity. Based on the results, your provider may advise a prostate biopsy to see if the cancer is growing faster. They may advise other tests as well. Your provider can also help you decide if and when you want to start treatment. For instance, you may decide to start treatment if your PSA reaches a certain level. Or you may start treatment if a biopsy shows the cancer is growing faster.

It's also important to let your provider know about any new symptoms you have. New symptoms may be a sign of the cancer growing. Ask your provider what symptoms to watch out for. And ask which symptoms mean you should call and be examined before your next scheduled appointment. 

Talk with your healthcare provider about factors that help you decide when to switch from active surveillance to start treatment.