Active Surveillance


When your doctor tells you that you have developed prostate cancer, you will understandably be anxious.

You may expect to be presented with a full-bore treatment program of surgery, radiation and medication. Sometimes, though, the best treatment for you may be active surveillance.

What is active surveillance?

Active surveillance is also sometimes called “watchful waiting.” It does not involve immediate treatment of the cancer. Instead, you will make visits to your doctor every few months to have your condition monitored. If there is a change, you may be scheduled for more aggressive treatment.

When is active surveillance the best choice?

More than 30% of men who are diagnosed with prostate cancer are eligible for active surveillance.

Many prostate cancers grow very slowly. If you are of an advanced age, your doctor may determine that the cancer is not likely to become a problem within your expected lifespan.

If your cancer is very small and localized, and it is not causing symptoms, it is often better to monitor it. Close monitoring will usually let your doctor catch any changes before the tumor becomes threatening.

You may have other health issues that make aggressive cancer treatment unadvisable. In this case, watchful waiting may be best for you.

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What happens during an active surveillance appointment?

The first step is for your doctor to perform a digital rectal exam. If you have been diagnosed with prostate cancer, you are probably already familiar with this procedure. It allows your doctor to feel the prostate and detect any troubling changes.

You will also get a PSA test. This blood test will detect a rise in an antigen that is associated with prostate cancer. Elevated levels of PSA may be a cause for concern.

If your prostate tumor shows signs of growth, your doctor may want to take an ultrasound or MRI image of your prostate. This produces a clearer image of the tumor and lets the doctor more accurately judge the changes.

Once you have been under active surveillance for a year, it is typical for your doctor to recommend a prostate biopsy. The biopsy collects a few cells from the tumor so they can be analyzed. The biopsy may be repeated every one to five years, and it may sample different areas of the prostate to make sure there are no hidden areas of cancer growth.

How long does active surveillance last?

If no changes are detected during your examinations, active surveillance can continue indefinitely. One study followed men for 15 years and found that the cancer metastasized in only 1% of them.

The crucial element for the success of active surveillance is that you keep your appointments. Becoming complacent and missing exams can give the cancer the opportunity to grow beyond the point where it can be easily treated.

Your doctor may decide to abandon active surveillance if your cancer begins to grow at an alarming rate. If the tumor spreads to other areas of the prostate or begins to produce symptoms that interfere with your quality of life, it may be time to pursue more assertive treatment.