Prostate Cancer: Active Surveillance

Not every man 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 not treat prostate cancer right away, but instead to watch it closely. Treatment can then be done later if the cancer is growing quickly or causing symptoms.

Active surveillance or watchful waiting?

Active surveillance is sometimes also called watchful waiting. And some healthcare providers see these as 2 different things. You may have more exams and tests over time with active surveillance, and fewer with watchful waiting. Your healthcare provider will tell you which term he or she uses, and what it means for you.

When active surveillance is a choice

Active surveillance may be a choice for you if:

• Your healthcare provider believes that your cancer is growing slowly

• You have a tumor that hasn’t spread

• You have a low Gleason score

• You’re older and don’t want to risk the side effects that treatments, such as surgery and radiation, may cause

• You are in poor health or have another serious health problem that makes prostate cancer a lower priority

Who probably should not use active surveillance

Active surveillance may not be a choice for you if:

• You are younger and have no other health problems

• Your cancer is growing quickly

• Your cancer was found early and may be cured

What to expect during active surveillance

You'll likely see your healthcare provider every 3 to 6 months. At each visit, your healthcare provider will likely give you a blood test. This is done to test the level of prostate specific antigen (PSA) in your blood. You will also have a digital rectal exam (DRE). You may also have a prostate biopsy each year. These tests can show signs that the cancer may be growing. 

If your PSA level starts rising, the healthcare provider will watch carefully how fast it is rising. This rate of change is called the PSA velocity. Based on the results, your healthcare provider may advise a prostate biopsy to see if the cancer is growing more quickly. He or she may advise other tests as well. Your healthcare provider can also help you decide if and when you want to have treatment. You and your healthcare provider may decide at what point you'll start treatment. For example, 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 more quickly.

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