Prostate Cancer: Active Surveillance

When you find out that you have prostate cancer, your natural reaction may be to want to get the cancerous tissue out right away. It’s a completely understandable — and normal — response. But not all prostate cancers are alike, and not all of them are equally aggressive or likely to spread. Sometimes, the best approach is just keeping a watchful eye on the disease, a strategy known as active surveillance. We may recommend active surveillance if you have:

  • a small tumor that’s limited to the prostate
  • a slow-growing cancer
  • a low risk that the cancer will grow locally or spread (metastasize) or that you’ll die from the disease

Active surveillance isn’t the right choice for everyone with localized prostate cancer. A number of men, given the possibility that a cancer could become more aggressive, prefer to eliminate even the smallest tumor and accept the risk of side effects from treatment. It’s a very personal decision, and we’re here to help you consider all your options and answer your questions or concerns.

What Happens during Active Surveillance

Active surveillance is a form of treatment. It’s not the same as receiving no treatment at all. With this method, we put off such treatments as surgery and radiation therapy because tests indicate that the tumor is currently not life threatening or is at a low risk of spreading or getting worse. Your doctors team up to actively monitor your tumor for any signs that this is happening and for any changes in the tumor’s characteristics and reevaluate your treatment if the cancer becomes more active. For example, if your Gleason score or PSA level starts to rise, we 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 you is determining as certainly as possible that the disease is confined to the gland and does not have aggressive features. To do this, we may want you to have 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, such as urinary incontinence (the involuntary loss of urine), rectal bleeding, and erectile dysfunction.