For some men, the best initial treatment for prostate cancer is no immediate treatment at all. Active surveillance means monitoring a low-risk cancer closely, with regular tests, and only starting treatment if there are signs it is changing. It allows many men to avoid or delay the side effects of surgery or radiotherapy without losing the chance of cure.
Why monitoring can be safe
Many prostate cancers grow very slowly. Some would never cause symptoms or shorten life. Treating every cancer straight away means some men would face the risks of treatment, such as effects on continence or erections, for a cancer that may never have harmed them.
Active surveillance aims to find the cancers that need treatment, while sparing men whose cancer is not a threat. NICE guidance on prostate cancer recommends offering it to men with low-risk disease, and it can be considered for some men with favourable intermediate-risk cancer.
Who it may suit
Active surveillance is usually suitable for men with:
- a cancer confined to the prostate
- a Grade Group 1 cancer, or a small amount of Grade Group 2 in some cases. Our guide to Gleason scores and Grade Groups explains these.
- a PSA level that is not high
- a small amount of cancer on biopsy
It is a choice, not an obligation, and you can change your mind at any time. Some men eligible for surveillance prefer treatment, and that is also reasonable.
Active surveillance is not watchful waiting
These terms are sometimes confused:
- Active surveillance: aims to cure the cancer if it changes. It involves regular PSA tests, MRI scans and sometimes repeat biopsies.
- Watchful waiting: usually for older men or those with other health conditions. It focuses on managing symptoms if they develop, with less intensive testing.
What follow-up involves
A typical surveillance programme includes:
- PSA tests: every three to six months in the first years.
- Rectal examinations: at intervals, in some programmes.
- MRI scans: usually after the first year and then at regular intervals. Our guide to mpMRI scans explains what to expect.
- Repeat biopsies: if PSA or MRI suggests a change.
The exact schedule varies between hospitals and is tailored to each man.
When treatment might be recommended
Your team may suggest treatment if:
- PSA rises significantly or quickly
- MRI shows the cancer growing or a new area appearing
- a repeat biopsy shows a higher grade or more cancer
- you decide you would prefer treatment
If treatment is needed, the aim remains cure, usually with surgery such as robotic prostatectomy or radiotherapy.
Living with monitoring
Some men find it reassuring to know their cancer is being watched carefully. Others find the uncertainty difficult, especially before test results. Our article on PSA anxiety looks at this worry and what helps.
Things that can help include:
- understanding the plan and what each test is looking for
- knowing who to contact with questions
- talking to others on surveillance through support groups
- keeping a record of your results
Prostate Cancer UK has a helpful guide and runs a support network.
Healthy habits during surveillance
There is no proven way to stop prostate cancer progressing, but staying active, keeping to a healthy weight, eating a balanced diet and not smoking all support your general health and fitness for treatment if it is ever needed.
Talking it through
Choosing between surveillance and treatment is a personal decision. It helps to understand the likely course of your cancer, the side effects of each option and how you feel about monitoring.
Professor Prokar Dasgupta can review your results and discuss whether active surveillance suits you at The London Clinic. Please contact the clinic to arrange a consultation.