Active Surveillance for Prostate Cancer

This information explains a treatment for prostate cancer called active surveillance.

Active surveillance is an option for men whose prostate cancer is slow-growing and is very unlikely to decrease their quality of life or affect how long they live.

Many prostate cancers grow slowly and do not cause problems in a person’s lifetime, while others grow more quickly. Based on your test results, your doctor can judge how quickly the cancer in your prostate will grow. If you have a slow-growing cancer, your doctor may recommend active surveillance. Many men with slow-growing cancer choose active surveillance.

During active surveillance, the prostate cancer is closely monitored over time. You will not have surgery or radiation therapy. As long as your risk of the prostate cancer growing remains low, your doctor will keep monitoring it. If your risk of the prostate cancer growing gets higher, then your doctor will recommend treatment, such as surgery or radiation therapy.

What to Expect During Active Surveillance

During active surveillance, your doctor will use different tests to watch for any changes in your prostate, including:

  • A blood test that measures your prostate-specific antigen (PSA) level. PSA is a normal protein made by your prostate gland. PSA levels typically increase when cancer is present. PSA levels often change during active surveillance. Your doctor will be looking for general trends instead of a change between each measurement.
  • A digital rectal examination (DRE). During a DRE, your doctor will use their finger to feel your prostate. A DRE is done to check for abnormalities in your prostate, such as hardness.
  • Magnetic resonance imaging (MRI) of your prostate. This will provide information about the location and size of the cancer.
  • A biopsy of your prostate, which uses a needle to get samples of tissue. The samples are checked for signs of cancer and given a Gleason score. A Gleason score lets your doctor know how likely the cancer is to spread.
  • Genetic testing of previously collected biopsy tissue. This will help your doctor to better assess the risk level of your prostate cancer. Not all people will need genetic testing.

Test schedule during active surveillance

If you and your doctor have decided that active surveillance is right for you, your doctor will discuss with you which tests you need and how often you need them. Below are guidelines for what tests you can expect and when, but it’s important to follow the schedule your doctor prescribed for you.

  • DRE and a PSA test every 6 months
    • In some situations, you will need to have your PSA test done at a lab closer to your home. If you and your doctor have discussed this option, please fax the results to:

      Dr. ___________________ at __________________ (fax).
  • Repeat prostate biopsy, MRI, or both within 6 months of your diagnosis
    • This is to confirm that your cancer is low risk and that you are a candidate for active surveillance.
  • Repeat prostate MRI every 18 months
    • If the results of this MRI are different than your previous results, you may need another prostate biopsy to evaluate the change.
  • Repeat prostate biopsy every 3 years
    • You will need to have these repeat biopsies even if your MRI results remain the same.


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Emotional Effects of Active Surveillance

Men who choose active surveillance may feel nervous at some point. They may worry that their cancer is growing without them knowing. However, it is important to remember that this is unlikely to happen and your doctor will be watching you closely.

Help is available for you at any time. If you would like counseling, your doctor or nurse can give you a referral to see a social worker, psychiatrist, or counselor.

Your family and friends may not understand why you are not receiving treatment for prostate cancer. You can explain to them that your doctor has determined that you have a slow-growing type of cancer that does not need to be treated with more traditional forms of cancer treatment such as surgery. Also, it is important to explain to them that active surveillance is a form of treatment and has been shown to be very effective to manage prostate cancers like yours.

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Other Information

It is normal for your stream of urine to get slower or feel like it is difficult to empty your bladder all the way. These are normal changes for men as they get older and have nothing to do with your prostate cancer.

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