Not all prostate cancers are equally aggressive. If you have a small tumor that is confined to the prostate, the cancer appears to be slow growing, and the risk of local growth, metastasis (spread), or death from the disease is low, your doctor may recommend an approach called active surveillance. In this approach, treatments such as surgery and radiation therapy are deferred because tests indicate that the tumor is currently not life threatening or is at a low risk of progressing.
Surgical oncologist Vincent Laudone describes the benefits of active surveillance for some men with early-stage, localized prostate cancer.
Active surveillance is a treatment. It is not the same as receiving no treatment. During active surveillance your doctor actively monitors your tumor for any signs of progression or change in its characteristics, and reevaluates your treatment if the cancer becomes more active. For example, if your Gleason score or prostate-specific antigen (PSA) level starts to rise, your doctor may recommend stopping active surveillance and starting another type of treatment.
The key to making certain that active surveillance is the appropriate treatment approach for your cancer is determining as accurately as possible that the disease is confined to the gland, and does not have aggressive features. This may require a second biopsy.
The advantage of active surveillance for men with localized, early-stage prostate cancer is that they can be spared the potential side effects of surgery and radiation therapy, including urinary incontinence, rectal bleeding, and erectile dysfunction.
Active surveillance is not the right choice for everyone with localized prostate cancer. Because of the possibility that a cancer could become more aggressive, some men prefer to eliminate even the smallest tumor and accept the risk of treatment side effects. If you have questions or concerns about active surveillance, you should discuss them with your doctor.